Drug-addicted babies more than twice as likely in Kentucky as in rest of nation, but few facilities accept addicted pregnant women

Amy Kalber of Louisville strokes her infant son, Marty Barkley,
in a family gathering. Her first two children were born addicted,
but the last two were born healthy during her recovery, described
by The Courier-Journal's Laura Ungar (C-J photo: Sam Upshaw)

A baby born in Kentucky is more than twice as likely to be addicted as a typical baby born elsewhere in the United States.

In 2013, the last year for which comparative figures are available, Kentucky had 15.1 cases of addiction per 1,000 live births; the national rate was 7.3, according to a research letter in the journal JAMA Pediatrics.

"Both were up substantially from five years earlier, and Kentucky’s rate jumped another 40 percent the following year," reports Laura Ungar of The Courier-Journal.

“We have mothers who are addicted throughout pregnancy and their addiction is more or less passed down to their babies,” researcher Joshua Brown, of the Institute for Pharmaceutical Outcomes and Policy at the University of Kentucky, told Ungar. “The trend just keeps going up and up and up.”

Addicted babies are one product of the state's issues with drugs, legal and illegal. “We’ve had one of the country’s worst prescription drug problems,” institute director Jeffrey Talbert told Ungar. “We need more treatment providers and more access to care.”

Especially for addicted mothers or mothers-to-be: "Only 30 of the 123 substance-abuse treatment facilities in Kentucky accept pregnant or post-partum women," Ungar reports. "Only eight are long-term residential programs."

"There are signs of progress," Ungar reports. "In 2015, Kentucky became one of 11 states to receive up to $3 million in federal grants to provide expanded treatment to pregnant addicts. That was in addition to $1 million in state funds for transitional care and other services that came from an appropriation in the anti-heroin bill passed that year. And on Wednesday, state officials announced they will apply for up to $10 million in federal ... funding to fight the opioid epidemic, and one of their priorities if they get it will be to help pregnant addicts."

A law co-sponsored by Senate Majority Leader Mitch McConnell of Kentucky "calls for, among other things, spreading proven practices to prevent and treat maternal opioid abuse and recommendations for treating drug-dependent infants," Ungar notes. 

U.S. Sen. Rand Paul suggests that if Kentucky wants to keep its Medicaid expansion, it should raise taxes to pay for it

U.S. Sen. Rand Paul suggested Sunday that Kentucky and other states that expanded Medicaid under federal health reform should have to raise taxes to keep it expanded and not rely on the federal government to continue the benefit.

Paul appeared on CNN's "State of the Union" to discuss his plan for replacing the law, which he said should be replaced the same day it is repealed. "Paul's plan did not directly address the future of states that signed on for expanded Medicaid offered as part of Obamacare," Gregory Kreig reports for CNN.

"That's the big question," Paul told host Jake Tapper. "And I don't think that's going to be in the replacement aspect."

He added, according to The Hill, "If Kentucky or Tennessee or Ohio wants to expand Medicaid, and they say, 'You have a lot of people struggling,' we're willing to help them, that's fine. . . . But we have no money in Washington. . . . So I'd say that if you want to have more Medicaid you should say we're going to have to have higher taxes to pay for it."

Those taxes could be considerable. Under the law, federal funds covered all the expansion cost through 2016. States are now paying 5 percent, and the law calls for that will rise in annual steps to its limit of 10 percent in 2020. Kentucky's share for 2017 and the first half of 2018 is estimated at $257 million.

The expansion covers people in households with incomes up to 138 percent of the federal poverty level (about $33,000 a year for a family of four). It added about 44,000 Kentuckians to the program and was largely responsible for cutting by more than half the percentage of Kentuckians without health insurance.

A spokesman for Senate Majority Leader Mitch McConnell, Kentucky's other senator, asked to reveal McConnell's plans for the Medicaid expansion, said in an email, "Sen. McConnell will have lots more to say about this issue in the coming weeks."

Paul said his replacement plan would allow health-insurance companies to offer cheaper plans with less coverage. "We're going to legalize the sale of inexpensive insurance," he said. "That means getting rid of the Obamacare mandates on what you can buy. We are going to help people save through health savings accounts, as well as a tax credit."

"Under Paul's program, the bargaining power created by the state and federal exchanges would be replaced with a provision that allows individuals and associations like small businesses to create their own markets," Kreig reports. "He added that those negotiations with insurance companies could also be used to guarantee the availability of policies that "can't cancel you and guarantees the issue of the insurance even if you get sick."

Paul told Tapper, "Our goal is to insure the most amount of people, give access to the most amount of people, at least the amount of cost."

However, Paul is just one of 100 senators, and President-elect Donald Trump says he has he own plan, which will have "insurance for everybody." Kreig notes, "Republicans have been at loggerheads over the timing and execution of their promise to repeal Obamacare and replace it with a cheaper alternative that will not disrupt the insurance market and leave millions of Americans without coverage."

Massie joins Paul in voting against bill to start Obamacare repeal; McConnell won't say what he has in mind for Medicaid expansion

Kentucky Health News

One Kentucky congressman was among the nine House Republicans who voted against a budget resolution that is the new Congress's first step toward repealing the Patient Protection and Affordable Care Act.

Massie (Breitbart.com photo)

Rep. Thomas Massie of Vanceburg "said he voted against the budget resolution because of the estimated $9.7 trillion it would add to the national debt," Lindsey McPherson reports for The Hill. "He said his fiscal conservative colleagues who voted 'yes' because they only saw the budget as a vehicle to get to Obamacare repeal will regret it."

"We got a Category 5 hurricane coming when you have to reduce to practice the differences between Donald Trump’s agenda and [House Speaker] Paul Ryan’s agenda," he said. "I think there are going to be some very confusing votes in here.”

The resolution passed 227-198, with all Democrats opposed. The Republicans against it were "a mixed bag," The Hill reports: "four members of the moderate Tuesday Group --  Charlie Dent and Brian Fitzpatrick of Pennsylvania, John Katko of New York and Tom MacArthur of New Jersey, and two members of the hard-right House Freedom Caucus, Justin Amash of Michigan and Raul Labrador of Idaho." The others were Massie, North Carolina Rep. Walter B. Jones and California Rep. Tom McClintock, "all of whom are conservatives but not members of the Freedom Caucus."

When the session opened with the vote for speaker, Massie was the only member who voted for Amash, who is chair of their libertarian-oriented Liberty Caucus. Amash called the resolution "the worst budget we've had since I've been in Congress. . . .  We can put together a good budget and also repeal Obamacare."

The resolution is not binding but provides a vehicle for Senate Majority Leader Mitch McConnell to prevent a Democratic filibuster against repealing parts of the health-reform law that relate to spending and taxes. It takes 60 votes to stop a filibuster and Republicans have 52 senators.

Massie, Amash and Paul (Photo via imgdex.com)

Sen. Rand Paul, R-Ky., was the only Republican senator to vote against the resolution, citing concerns similar to Massie's and saying it would add $9.7 trillion to the national debt over the next decade. He unsuccessfully pressed the House Freedom Caucus to stand against it.

After that meeting, Massie challenged Republican leaders' argument that the resolution is merely a vehicle to repeal Obamacare: “If they want to tell us these are pretend numbers, then why do your pretend numbers not even balance?”

Massie told Bridget Bowman of Roll Call that the episode showed why he opposes Ryan and other leaders. “We’re given a lose-lose proposition,” he said. “You either vote to keep Obamacare or you vote to add $10 trillion to the budget when in fact it would be so easy to have a conservative budget that repeals Obamacare.”

Mike DeBonis of The Washington Post writes, "It will now only get harder for Republicans," DeBonis writes. "They must assemble a viable replacement for a law that has expanded health insurance coverage to roughly 20 million Americans and eliminated unpopular insurance industry practices, such as lifetime coverage caps and widespread refusal to cover already-sick individuals. Republican leaders have instead focused on the Affordable Care Act’s flaws — rising premiums for plans sold in state marketplaces, high deductibles and burdensome taxes. GOP lawmakers are set to gather in Philadelphia later this month to hash out a more complete alternative."

Several senators from states that expanded the Medicaid program with federal money through the reform law want to see its replacement before voting on the repeal. Kentucky is one of the states that has benefited most from the law, adding more than 400,000 people to Medicaid and cutting by more than half the percentage of Kentuckians without health insurance.

McConnell, in a news release after the Senate vote, mentioned various problems with private insurance under Obamacare but said nothing about Medicaid. Asked what he plans to do with the Medicaid expansion, his spokesman, Robert Steurer, replied via email, "Sen. McConnell will have lots more to say about this issue in the coming weeks."

Ky. has 25 approved syringe exchanges to reduce risk of HIV and hepatitis C outbreaks; other counties debate proposals

By Melissa Patrick
Kentucky Health News

A minister, a nurse and a physician assistant joined forces in Powell County to educate its citizens about a syringe-exchange program, which should open up this month -- but the decision to support an exchange didn't come easily for any of them, Mary Meehan reports for Ohio Valley ReSource, a regional journalism collaborative of public broadcasters.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, told Meehan that rural counties like Powell are leading the way in changing the perception of how addiction is perceived in the state, shifting the focus toward treatment and public health initiatives and away from the criminal justice system. So far, syringe exchanges have been approved in 25 of the state's 120 counties; several others are having debates like the one that went on in Powell County.

Pastor Brad Epperson of the Clay City First Church of God, who also drives a school bus, told Meehan that the many funerals he has officiated for people too young to die, and the stories he hears from the children on his bus, made him realize that something had to change. He now considers syringe exchanges the first place for addicts to get the help they need.

Nurse Mandy Watson
(Photo by Mary Meehan)

Mandy Watson, a nurse for the Powell County Board of Health, told Meehan that she changed her mind about syringe exchanges after realizing what an HIV or hepatitis C outbreak could do to the community.

The federal Centers for Disease Control and Prevention ranks Powell County 15th in the U.S. for risk of an HIV or hepatitis C outbreak from IV drug use, and the county borders Wolfe County, which is ranked No. 1 in the nation.

"Almost anybody you ask has some kind of family member who does use or (has) some type of trouble with addiction," Watson said of the county, where 13,000 people live.

Physician assistant Troy Brooks, who is on the county health board, initially opposed a syringe exchange. "He said it seemed like a way to let addicts keep using their drug of choice without consequence," Meehan reports. But then local police showed him how bad the problems is by taking him to the Clay City playground, where they collected 41 dirty needles, and he saw the need to protect children and first responders.

Tosha Baker of the Clay City Times did a story June 2 about needles in the park and elsewhere, and the discussion of a syringe exchange.

The state legislature authorized syringe exchanges in the 2015 anti-heroin bill, but in an effort to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding.

Six of the 25 syringe exchanges approved so far aren't operational yet. Thirteen are in counties deemed most vulnerable counties by the CDC, which identified 54 Kentucky counties as among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among persons who inject drugs. Sixteen of the state's counties ranked in the nation's top 25.

Cabinet for Health and Family Services map; updates at http://chfs.ky.gov/dph/epi/HIVAIDS/prevention.htm

The Madison County Board of Health supports a syringe exchange, but was met with "mixed feelings" about the program at the August fiscal court meeting, with some members concerned that the program condoned intravenous drug use, Ricki Barker reports for The Richmond Register.

The county will host several forums to educate local citizens about the cost and benefits of the program and answer any questions that the public may have about it. Health officials told Barker that the department sees about eight to 10 patients a day with hepatitis C.

Woodford County has received a $6,860 grant from the Kentucky Agency for Substance Abuse Policy that will be used to seed a syringe exchange program if approved by the local governments.

Securing a needle exchange in Northern Kentucky continues to depend on what Campbell County decides to do, Chris Mayhew reports for Cincinnati.com.

The Northern Kentucky Health Department wants to put a needle exchange program in the Campbell County Health Center in Newport, but Newport hasn't yet approved an exchange, despite a strong push from health officials since 2015 to do so. Mayor Jerry Rex Peluso, who supports an exchange, told Mayhew that the four city commissioners remain divided on this issue.

Intravenous drug use is so bad in Northern Kentucky that the health department created a "story map" to utilize "big data" to help combat the heroin epidemic in the area, noting that one person in Northern Kentucky died from a drug overdose every 40 hours last year. The map shows the areas with the highest number of opioid-related arrests since 2011, opioid related medical runs and where naloxone was administered; where you can get naloxone, among other things, Jay Warren reports for WCPO-TV in Cincinnati.

Several exchanges are newly approved or just getting started

Boyle and Whitley counties started their syringe exchanges Jan. 13.

Boyle County's program is open 1 to 3 p.m. Fridays in the basement of the health department in Danville, Kerry Steinhofer reports for The Advocate-Messenger. The program is initially being funded by a $20,000 ASAP grant, which will pay for supplies, but not salaries. Health officials said the hope is that the city and county will eventually fund the program.

Whitley County's exchange is open from 2 to 4 p.m. Fridays at the health department's main office in Williamsburg. Whitley County is ranked the 14th most vulnerable county in the nation for a rapid outbreak of HIV or hepatitis C infections, Mark White reports for the News Journal, the local weekly newspaper.

“Needle exchanges are the only thing they have shown that truly decreases hepatitis. Hepatitis C has become the number one killer in the state,” Public Health Director Martha Steele told White.

Mike James of The Daily Independent in Ashland reports that Greenup County recently approved a syringe exchange. The program will cost about $8,000 per year, including materials and will be funded by the local health department and a grant from Pathways Inc., a behavioral-health nonprofit. The program will be operated out of the health department one day a week for three hours a day. James reports that "users also will get counseling from a Pathways Inc. professional."

Floyd County will also begin offering its program in January as well, Andrea Saddler reports for The Floyd County Times. The county health department is conducting a survey to determine the best day to operate its exchange.

Nelson County approved its program in December, but it's not operating yet, Jim Brooks reports for the Nelson County Gazette. This exchange will be one-for-one and will be funded by the health department.

Warren County's excahnge opened in September and reports that it is off to a good start, seeing about a dozen people each week, Alyssa Harvey reports for the Bowling Green Daily News. It is open Thursdays from noon to 4 p.m. at the Barren River District Health Department.

Brad Stacy of The Morehead News reports that "the city, county and board of health approved a harm-reduction program that focuses on limiting the risks and harms associated with unsafe drug use, including needle exchange" after a standing-room-only crowd at a community forum discussed the heroin problem in the county.

Click here for a list of operating needle exchanges and their hours of operation.

Louisville's program grows, make case against one-for-one rule

The Louisville syringe exchange opened its fourth location in December at the Redeemer Lutheran Church in the Shawnee neighborhood. It will be open every Tuesday from 9 a.m. to noon, Joe Sonka reports for Insider Louisville.

"Statistics provided to Insider Louisville by the city health department show that from the program’s inception through the end of this October, a total of 5,347 individual clients have received 454,989 free syringes, with 267,746 used syringes returned," Sonka reports. He also notes that 295 clients in the exchange have been referred to drug treatment programs, two have tested positive for HIV and 182 have tested positive for hepatitis C.

Sonka reports that Louisville's exchange is the only one in Kentucky that uses a needs-based model, which is considered best practice by leading health experts to prevent the spread of disease. Other programs in the state place some limits or follow a one-for-one policy, as the state is requiring for exchanges that get state grants.

Stat, the science-and-medicine supplement to The Boston Globe, reports, "Needle exchanges, once met with fierce resistance, are working" and notes that public-health experts say that one of the challenges in decreasing infections is "that exchanges do not provide as many clean syringes as people who use drugs need."

Jan. 31 is last day to sign up for insurance on HealthCare.gov if you didn't have a 2016 health plan on Kynect; March 1 if you did

By Melissa Patrick
Kentucky Health News

Jan. 31 is the deadline for Kentuckians who did not have health insurance through Kynect last year to sign up for health insurance through the federal exchange, now being used for enrollment instead of Kynect. If you do not have health insurance, you face a steep penalty when it comes time to file your tax returns.

Kentuckians who had a health insurance plan through Kynect in 2016, with coverage ending Dec. 31, have been granted an extension and can sign up on HealthCare.gov until March 1, with coverage beginning April 1. In order to qualify for the extension, applicants must check the "loss of qualifying coverage" box on the HealthCare.gov application, and provide the last date of coverage.

This is the first year Kentuckians have signed up for health insurance on the federal exchange. Gov. Matt Bevin largely dismantled Kynect prior to the 2017 enrollment period, calling it redundant, but it still has a website that can be used to find insurance agents or application assisters, formerly called Kynectors.

The Cabinet for Health and Family Services told Kentucky Health News in October that application assisters were available in every county to help people sign up for coverage.

You can find an assister in your area by clicking on the "kynectors/Application Assisters" tab on the Kynect site or calling Kynect's call center (855-459-6328), which is also available to help you sign up for coverage. The HealthCare.gov customer service call center (800-318-2596) can also help and is open 24 hours a day, seven days a week.

The Patient Protection and Affordable Care Act requires most people to have health insurance, or pay a penalty. For 2017, the penalty for not having health insurance is 2.5 percent of your income or $695 per adult and $347.50 per child, with a maximum of $2,085 per household, whichever is higher.

There are a few exemptions, including:certain hardships, membership in some groups, some life-changing events, incarceration, if health coverage is considered unaffordable, or if household income is below the threshold for filing a tax return, according to HealthCare.gov.

If you miss the deadlines, the only way to buy health insurance on the federal exchange is if you have a major life event, like marriage or a change of employment. Those who qualify for Medicaid can apply year round.

Kentucky had 70,542 people sign up for individual health plans on the federal exchange during the regular 2017 open enrollment period, which ran Nov. 1 through Dec. 31, according to the Centers for Medicare & Medicaid Services.

Last year at the same time, 68,319 Kentuckians had signed up for private plans through Kynect. Overall, around 82,000 people were enrolled in private plans in Kentucky last year, according to the Cabinet for Health and Family Services.

A separate CMS report said that between Nov. 1 and Christmas, 78 percent of the 67,915 Kentuckians who had signed up for coverage on the federal exchange received a tax credit to help pay for their policy, and the average credit was $275.

Senate takes first step toward repealing Obamacare; Rand Paul, worried about deficit and debt, is only Republican to vote no

Paul, McConnell (Washington Post photo)

Citing concerns about the federal budget deficit and the national debt, Rand Paul of Kentucky was the only Republican senator to vote against a non-binding resolution that paves the way for repeal of the Patient Protection and Affordable Care Act.

Passage of the resolution early Thursday morning was led by Kentucky's other senator, Majority Leader Mitch McConnell, who said, "We must act quickly to bring relief to the American people."

Paul said in a press release, “As a physician, I cannot wait to repeal Obamacare and replace it with a health care system that relies on freedom to provide quality, comprehensive, and affordable care. But putting nearly $10 trillion more in debt on the American people’s backs through a budget that never balances is not the way to get there. It is the exact opposite of the change Republicans promised, and I cannot support it, even as a placeholder.”

The House may vote on the measure Friday, but "some Republicans there have misgivings about setting the repeal effort in motion without a better idea of the replacement plan," Andrew Taylor reports for The Associated Press.

President-elect Donald Trump said Wednesday that "Obamacare" would be replaced at virtually the same time it is repealed. "That promise, however, will be almost impossible to achieve in the complicated web of Congress, where GOP leaders must navigate complex Senate rules, united Democratic opposition and substantive policy disagreements among Republicans," Taylor writes. "Republicans are not close to agreement among themselves on what any 'Obamacare' replacement would look like."

Taylor offers background: "The 2010 law extended health insurance to some 20 million Americans, prevented insurers from denying coverage for pre-existing conditions and steered billions of dollars to states for the Medicaid health program for the poor. Republicans fought the effort tooth and nail and voter opposition to Obamacare helped carry the party to impressive wins in 2010, 2014, and last year."

Thursday's vote "set up special budget rules that will allow the repeal vote to take place with a simple majority in the 100-member Senate, instead of the 60 votes required to move most legislation," Taylor writes. "That means Republicans, who control 52 seats, can push through repeal legislation without Democratic cooperation. They're also discussing whether there are some elements of a replacement bill that could get through at the same time with a simple majority. But for many elements of a new health care law, Republicans are likely to need 60 votes and Democratic support, and at this point the two parties aren't even talking. . . . Increasing numbers of Republicans have expressed anxiety over obliterating the law without a replacement to show voters."

Paul has been working with members of the conservative House Freedom Caucus, who want to know details or put some elements of replacement in the repeal bill. "Some GOP senators have discussed a phase-in of three years or longer to give lawmakers more time to replace Obama's overhaul and make sure people now covered by that law can adjust to a new program," Taylor notes. "Some more moderate House Republicans were unhappy, too, including Rep. Tom MacArthur, R-N.J., a leader of GOP centrists in the House Tuesday Group. He said he would oppose the budget because there was too little information about the replacement, including whether people receiving expanded Medicaid coverage or health care subsidies under the existing law would be protected.

"We're loading a gun here," MacArthur said. "I want to know where it's pointed before we start the process."

As patient-safety penalties hit hospitals, expert wonders why they aren't improving more; could be eliminated by Obamacare repeal

This is the third year federal government will apply penalties to hospitals that fall short of patient safety standards, leading one Consumers Union leader to wonder why hospitals aren't working harder to eliminate the infections and complications that are causing them to loose money, Trudy Liberman writes in her column for the Rural Health News Service.

“What I am most frustrated about is the lack of urgency in the country and at the agencies for eliminating these infections," Lisa McGiffert, head of the Consumers Union Safe Patient Project, told Liberman. "They are aware of them, but there’s not a sense of urgency to stop them."

"The penalties, along with the entire program to eliminate hospital-acquired conditions, were authorized under the Affordable Care Act," Liberman writes. "They could be in jeopardy if the law is repealed. Some hospitals probably would be happy if they disappeared."

Penalties are levied against hospitals that have a high number of patients with avoidable infections and complications, including blood clots, urinary-tract and surgical-site infections, bed sores and falls. And this year, infections related to antibiotic-resistant infections, like methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile, have been added to the list.

"The federal Agency for Healthcare Research and Quality says there were 3.8 million hospital injuries last year. That translates to 115 injuries per 1,000 patient stays," and "antibiotic-resistant bacteria infect some two million people annually. One quarter of a million cases occur in hospitals," Liberman notes.

Medicare will impose a 1 percent cut in payment to 769 U.S. hospitals who fell short of these patient safety standards in the fiscal year that ended Sept. 30. Eleven Kentucky hospitals were on the list, two more than last year, but five Kentucky hospitals that were penalized last year are not on this year's list.

Since the inception of the penalty program, Lieberman reports, 241 hospitals have been punished in all three years, but 347 that were penalized last year are not on the "bad-guy list."

Critical-access hospitals (by definition, rural) and specialized hospitals that treat psychiatric patients, veterans and children are exempt from the penalties.

"Larger teaching hospitals could lose as much as $1 million or more," Lieberman writes. McGiffert told her that the penalties have gotten the attention of hospital CEOs.

McGiffert said that as recently as 12 years ago, hospitals said infections were not preventable, but, “Now, most people in health care believe most infections are.” She also noted that government agencies have only recently started reporting hospital mistakes and other data to help patients.

McGiffert said patients should use the data to decide where they go for care when they have a choice. She suggested that they look for improvements from one year to the next, which could indicate that that particular hospital' emphasis on patient safety. She also encouraged patients to ask questions if the numbers show a hospital isn't performing as well as it has in the past.

Click here and follow the prompts to learn about Kentucky hospitals. You can compare three at a time. Click on the tab for "complications" to learn more about surgical complications and healthcare-associated infections in each of the facilities.

Reformulation of OxyContin to make it abuse-deterrent is main reason for shift to heroin and deaths from it, study concludes

By Melissa Patrick
Kentucky Health News

The reformulation of  OxyContin in 2010 is the main reason for the large increase in heroin overdose in recent years, according to a working paper by the RAND Corp. and the Wharton School of economics at the University of Pennsylvania.

Purdue Pharma released OxyContin as a 12-hour-release opioid for acute or chronic pain in 1996. The original formulation could be easily crushed or dissolved, allowing a person to get the 12-hour dosage all at once, making it ripe for abuse.

In 2007, Purdue Pharma pleaded guilty to misleading consumers about the risk of abuse associated with the drug and paid $600 million in federal fines. In 2010, it released a new formulation of OxyContin that made it "abuse-deterrent," the first drug to get this designation from the Food and Drug Administration. The report says the formula reduced non-medical OxyContin use as much as 40 percent.

This effort, along with prescription-monitoring programs and "pill mill" laws in Kentucky, Florida and other states, have all been credited with reducing prescription-painkiller deaths, but also the increase in the abuse of "substitute" opiates such as heroin and fentanyl.

Click on chart to see a larger version of it

Kentucky has one of the highest OxyContin misuse rates in the nation, at 0.97 percent, says the report. To combat this, the state instigated the Kentucky All-Schedule Prescription Electronic Reporting (KASPER) system and passed a pill-mill bill in 2012 that put additional restrictions on pain clinics and requires people who have certain controlled-substance prescriptions to submit to a regular urine test.

In 2015 Kentucky had 1,220 total overdose deaths, with 605 of them from prescription opioids and 289 from heroin. Five years earlier, 538 of the 996 total overdose deaths were from prescription opioids and only 34 from heroin, according to the Kentucky Injury Prevention and Research Center.

The study, statistically controlling for the monitoring programs and pill-mill laws, concluded that the reformulation of OxyContin played a larger role in the shift to heroin, accounting for "as much as 80 percent of the three-fold increase in heroin mortality since 2010," the study report says.

Researchers based their conclusion on the differences in heroin deaths after 2010 in states that had differing rates of OxyContin abuse before then.

"States with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths," they write. "Results show that this differential increase in heroin deaths began precisely in the year following reformulation."

It also found that prior to 2010, there was no correlation between OxyContin abuse and heroin deaths. "Both the levels and trends in heroin deaths were nearly identical across states with high or low initial rates of OxyContin misuse before 2010," the study report said.

Graph is from the report, deaths per 100,000
 Data from the National Vital Statistics System

The study found that after the OxyContin reformulation in 2010, prescription opioid abuse and overdose deaths from them in the U.S. decreased for the first time since 1990, but this drop coincided with "an unprecedented rise in heroin overdoses," which "more than tripled between 2010 and 2014 (from 1.9 to 3.4 deaths per 100,000)." Heroin was responsible for the deaths of more than 10,000 Americans in 2014.

"Each percentage-point reduction in the rate of OxyContin misuse due to reformulation leads to 3.1 more heroin-related deaths per 100,000," the study report said. It also said the "impact of the reformulation on heroin and opioid deaths largely offset each other, leading to no net reduction in overall overdose deaths."

The study concluded that "supply-side strategies," like creating abuse-deterrent drugs, as the FDA is actively encouraging, or making it harder for patients to gain access to them, won't solve the nation's drug problems. However, it said they could deter new abuse: "Treating underlying demand may prove to be the more effective strategy for dealing with the current opioid epidemic, particularly because substitutes are readily available."

Data for the report, published by the National Bureau of Economic Research, is from the National Survey on Drug Use and Health and the National Vital Statistics System.

Sen. Rand Paul offers plan to repeal most of Obamacare; would remove requirement to cover pre-existing conditions

U.S. Sen. Rand Paul of Kentucky "is gathering support among Republican lawmakers for an ACA replacement plan designed to make health insurance less expensive by lifting many of the health law’s key requirements," including coverage of pre-existing conditions, which President-elect Donald Trump wants to keep, Alex Ruoff reports for the Bureau of National Affairs, a Washington newsletter service.

Kentucky was one of the states helped most by the law's requirement to cover pre-existing conditions, according to a recent report by the Kaiser Family Foundation. It said 33 percent of non-elderly Kentuckians, about 880,000 people, had pre-existing conditions that would have allowed companies to refuse to insure them.

Paul's plan would also remove the requirement that all Americans have health insurance, which was designed to balance insurance companies' coverage of pre-existing conditions. "The plan, similar to those floated by House Republicans recently, would expand use of tax-advantaged health savings accounts to help people afford the cost of health services," Ruoff reports.

Sen. Rand Paul

“What we need to do is make available inexpensive insurance so healthy people will buy it,” Paul said.

Paul has been leading a push against the plan of Kentucky's other senator, Majority Leader Mitch McConnell, and other Republican leaders to repeal budget-related elements of Obamacare with a budget resolution, which is not subject to a filibuster and the 60-vote requirement to end it, and pass replacements elements later.

"Paul said he still supports using the budget reconciliation process to repeal the health law, but acknowledged a replacement plan would need to be passed outside reconciliation and require support from some Democrats," Ruoff writes. There are 52 Republican senators.

"Paul’s replacement plan tracks along the plans other conservatives have introduced in recent weeks, with some key differences. He’s among those calling for the most aggressive repeal and replace timeline as well," Ruoff reports. "Paul’s plan would lift nearly all the ACA’s major provisions and mandates, including the mandate that certain employers give their employees health insurance coverage, and would roll back requirements that define what benefits insurers must provide enrollees, known as essential health benefits."

Obesity is top health concern for children, cancer the biggest concern for adults in the latest Kentucky Health Issues Poll

Kentucky adults said cancer is the top health concern for both men and women in the Commonwealth, while obesity is the top concern for children, according to the latest Kentucky Health Issues Poll.

The poll, taken Sept. 11 through Oct. 19, found that 25 percent of Kentucky adults said obesity was the most important health issue facing children, followed by problems with health insurance and health care (10 percent), cancer (8 percent) and hunger or malnutrition (6 percent).

"One in four adults said obesity was biggest health issue for Kentucky's children, and they're right," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, co-sponsor of the poll.

"Unhealthy weights during childhood lead to a myriad of chronic conditions in adulthood, including heart disease, diabetes, high blood pressure, and bone and joint problems," Chandler said. "We've made some progress with our youngest children, but Kentucky ranks near the bottom, 40th out of 43 states reporting, for high school student obesity rates."

As for adults' concerns, cancer was followed by heart disease, problems with health insurance or health care, and obesity. Cancer and heart disease are leading causes of death for both men and women in Kentucky; Kentucky's cancer death rate is the nation's highest.

Kentucky leads the nation in obesity rates for both adults and children, ranking fifth for adult obesity and third for high-school obesity, and the numbers keep rising.

Source: State of Obesity report

The obesity rate among high-school students increased to 18.5 percent in 2015 from 16.5 percent in 2011, and the adult obesity rate rose to 34.6 percent from 30.4 percent in the same period, says The State of Obesity report. But the rate for toddlers (ages 2-4) decreased to 13.5 percent, from 15.6 percent.

The foundation's "Investing in Kentucky's Future" initiative provides funding, training and technical assistance to six community health coalitions across the state toward improving the health of Kentucky's children so that they can grow up to be healthy adults. The hope is that these programs can be replicated in other parts of the state.

The poll also found that concerns about Kentucky's children being hungry and malnourished have increased since 2010, the last time the KHIP asked this question. The concern was voiced by 6 percent in 2016, up from 1 percent in 2010. This lines up with reported increases in food insecurity for children in the state, at 23 percent in 2014,  up from19 percent in 2010, according to the latest data available from the Annie B. Casey Foundation's national Kids Count data center.

Concerns about health insurance and health care have also increased since 2010, with around 10 percent of respondents saying health-insurance and health-care problems were an important issue for each population in 2016. In 2010, 4 percent of women and 2 percent of men said they were concerned about health care or health insurance.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones, and each result has an error margin of plus or minus 2.5 percentage points.

Meth labs were more prevalent in 'dry' counties in 2004-2010; adds to evidence that making alcohol legal decreases drug use

Meth use is more prevalent in counties where the sale of alcohol is illegal, say researchers at the University of Louisville. They looked at meth-lab seizures in Drug Enforcement Administration records and local-option ordinances in Kentucky counties from 2004 to 2010, and found that "the number of meth-lab seizures in Kentucky would decrease by 34.5 percent if all counties became wet." (UofL maps: Meth lab seizures by county, with green indicating more busts; alcohol status: red for wet, orange for moist or limited, and yellow for dry)

In 2010 Kentucky had 39 "dry" counties (where all alcohol sales are banned), 32 "wet" counties (sales are allowed), 20 "moist" counties (contain some wet jurisdictions) and 29 "limited" counties (sale by the drink in restaurants meeting certain criteria). All the dry counties were rural; several have since gone wet or moist.

For the study period the mean lab-seizure rate was 2.17 per 100,000 residents in wet counties, 2.26 in moist counties and 3.92 in dry counties. The highest rates of lab seizures were along the border of Tennessee, a state in which beer is generally available but stronger drink is less so.

Christopher Ingraham of The Washington Post reports, "After running some statistical tests, the researchers found that this is more than just a simple correlation." They said, "Our results add support to the idea that prohibiting the sale of alcohol flattens the punishment gradient, lowering the relative cost of participating in the market for illegal drugs."

"In other words: people who buy alcohol in places where it's illegal become accustomed to dealing with the black market," Ingraham writes. "If you're going to get punished whether you trade in booze or trade in meth, why not give meth a spin?" (Post graphic using data from UofL study)

The UofL research "fits in with other findings showing harmful effects of localized alcohol prohibitions," Ingraham writes. "A 2005 paper in the Journal of Law and Economics found that when Texas counties changed from dry to wet, their incidences of drug-related mortality decreased by 14 percent as people substituted alcohol for other drugs. Records from the Kentucky State Police show that dry counties tend to have higher rates of DUI-related car crashes than wet ones, presumably because when you live in a dry county, you have to drive farther to get your booze. A 2010 report from the Robert Wood Johnson Foundation found that binge drinking rates were often higher in Alabama's dry counties than its wet ones."

Study says removing Medicaid expansion and premium subsidies, without replacement, would cost 45,000 jobs in Kentucky in 2019

By Melissa Patrick
Kentucky Health News

Repealing and not replacing two key parts of the Patient Protection and Affordable Care Act – expansion of the Medicaid program and subsidies for private insurance – could cost 45,000 Kentuckians their jobs in 2019, according to a new study.

The study is from the Milken Institute School of Public Health at the George Washington University and The Commonwealth Fund, a New-York based research foundation that says it promotes "a high-performing health-care system."

Republicans say they will soon "repeal Obamacare" but have been much less certain about what would replace it, and when. The study considers what would happen if Congress repeals and doesn't somehow replace the premium tax credits that help low- and middle-income Americans buy insurance on government exchanges, and the federal payments to states that expanded Medicaid to those who earn up to 138 percent of the federal poverty level.

The study used an economic forecasting model based on federal spending for Medicaid expansion and tax credits that subsidize insurance policies on the exchanges, and on Congressional Budget Office budget projections, with a multi-region model to account for interstate activity.

The study abstract says, "If replacement policies are not in place, there will be a cumulative $1.5 trillion loss in gross state products [the sum of value added from all industries in each state] and a $2.6 trillion reduction in business output from 2019 to 2023. States and health-care providers will be particularly hard hit by the funding cuts."

The study predicts that about one-third of the jobs lost in Kentucky would be in health care, but losses are also projected in construction, real estate, retail, finance, insurance and other industries. It forecasts that Kentucky's gross state product would fall $22.9 billion from 2019 to 2023; business output would fall $40.6 billion; and state and local taxes would decrease by $718.3 million.

"Federal funding thus initiates an economic cycle that ripples throughout the economy, both within and across state borders," the study report says. "The gains from this cycle also generate additional state and local tax revenues. When federal funds are cut, the results play out in the other direction, triggering losses in employment, economic activity and state and local revenues."

Chart from Commonwealth Fund report

The study also considered the impact of repealing and not replacing each of the two provisions alone. It estimated 13,200 lost jobs in 2019 from the repeal of premium subsidies and 31,400 from the repeal of the Medicaid expansion.

The report says that repealing and not replacing the expansion and the subsidies would be "particularly detrimental" to health-care providers, causing safety-net facilities, such as public hospitals and community health centers, to be hit especially hard by having to provide care for which they would not be paid.

Through the Medicaid expansion and premium subsidies, Kentucky had the largest drop in low-income, working-age people without health insurance, falling from 38 percent in 2013 to 13 percent in 2015, according to a separate Commonwealth Fund report.

"We do have research showing it’s provided a great deal more access,” former U.S. Rep. Ben Chandler, president of the Foundation for a Healthy Kentucky, told Bill Estep of the Lexington Herald-Leader. "However, the Kentucky Hospital Association has complained about the law hurting hospitals’ revenue and forcing layoffs," Estep noted. "On Thursday, Senate Majority Leader Mitch McConnell said the law has been a disaster," citing increases in premiums and deductibles and fewer companies selling policies on the exchanges.

Read more here: http://www.kentucky.com/news/state/article124821529.html#storylink=cpy

Commonwealth Fund Vice President Sara Collins told Estep that the issues that exist in the law with affordability could be fixed through legislation, and “The law is generally functioning very well.”

The report offers this caveat: "It is important to note that other health policy changes, or even changes to tax policy, could modify our projections. We focus on these two repeal policies alone because it is not yet clear what additional policy changes might be advanced."