U of L therapy provides hope for victims of movement disorder

A neurologist at the University of Louisville has developed a rehabilitation program for functional movement disorder, a recently defined condition manifested by unusual, involuntary movements or body positions. It is one of only a few in the nation, and has a high success rate, says a news release from U of L Physicians.

Kathrin LaFaver, director of the Parkinson’s Disease and Movement Disorders Clinic at the university, modeled the Motor Retraining Program after one at the Mayo Clinic. It combines neurological treatment, psychological counseling, and physical and occupational therapy during a week-long inpatient therapy that aims to improve patients’ motor symptoms, help them regain control over abnormal movements and develop better coping skills.

Kathrin LaFaver, M.D.

“Functional disorders are in the borderland between neurology and psychiatry, and there is a lack of treatment programs for the conditions,” LaFaver said in the release. “Diagnostic tests do not reveal a cause for the FMD, so patients experiencing symptoms often are told by neurologists that ‘nothing is wrong,’ and may be referred to a psychiatrist.”

FMD patients often complain of fatigue and difficulties with concentration and thinking. The disorder can be triggered by psychological or physical stress or trauma, and is not revealed in traditional imaging or other diagnostics, the release says.

Patients from 25 states have undergone the therapy at UofL. More than 85 percent of patients have shown improvement in their symptoms after one week of treatment, and 69 percent report the improvement of symptoms was maintained after six months, the release says.

One was Julia Semple of Delaware, who "spent 10 years trying to figure out what was wrong," the release says.

“It started with my head sort of twitching back and forth, like when you shake your head ‘no.’ It was completely involuntary,” Semple explained. “It progressed to other areas of my body over time. You know when you relax and you have a little twitch? Imagine that except a hundred times bigger and over and over again so you could never fall asleep. It was horrible.”

The disorder "interfered with Semple’s sleep as well as her work as a massage therapist and dancer," the release says. "Semple experienced significant improvement during her week of intensive therapy tailored to her individual needs and symptoms."

Semple said, “After a decade of people telling me ‘take a vacation,’ or ‘there is nothing wrong with you,’ the care at UofL and Frazier was the best ever. Everyone – whatever their part was – they really cared. . . . All of my life was wrapped up in trying to manage these symptoms. The treatment literally gave me my life back.”

Paducah expands smoking ban to e-cigs, private workplaces

Paducah has expanded the anti-smoking ordinance that it first passed in 2006.

The city commission voted 4 to 1 on Tuesday, April 10 to apply the ban to electronic cigarettes and private places of employment, making it comprehensive. “This is based on evidence that these types of ordinances make an impact on the smoking rates," Mayor Brandi Harless said.

"This amended ordinance also prohibits smoking in municipal and school-owned outdoor sports arenas and amphitheaters, public or private owned outdoor playgrounds, shelters, swimming pools, and spray-grounds, and municipally-owned outdoor public parks, playgrounds, trails, shelters, swimming pools, and spray-grounds," reports James Long of KFVS-TV in Cape Girardeau, Mo. "Smoking now is prohibited in city-owned vehicles, and each city vehicle is required to have one no-smoking sign."

The smoke-free ordinance still exempts private vehicles, retail tobacco stores, government and higher-education workplaces designated under KRS 61.165, private organizations or clubs, and private dwellings (unless used as a child-care facility), adult day-care centers, assisted-living facilities, hotel or motel guest rooms, screened gazebos, and the golf course at the city's Paxton Park, Long reports. It also exempts health-care facilities, which usually ban smoking on their own.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, praised the commission's action: "The comprehensive law now protects residents from secondhand smoke in all public spaces and workplaces and covers e-cigarettes as well as traditional cigarettes. This policy ensures that all who live, work and visit in Paducah can enjoy their right to breathe air that is free of tobacco smoke and related emissions. Studies show that comprehensive smoke-free laws decrease hospital admissions for emphysema and ER visits for asthma, reduce heart attacks and strokes, prompt more smokers to quit, and discourage youth from starting to smoke. These laws also benefit business by reducing health care, cleaning and maintenance costs and improving working productivity."

Surgeon general urges friends and relatives of drug users to get overdose-reversing drug naloxone; issues public health advisory

Adams and Jody Jaggers of Kentucky Pharmacists
Association's Pharmacy Emergency Preparedness
(Photo by Mary Meehan, Ohio Valley ReSource)

The U.S. surgeon general has issued the first health advisory in 13 years, calling for everyone who has family or friends with any risk of opioid overdose to get naloxone, a drug that can reverse an opioid overdose, and learn how to use it. More than 1,400 Kentuckians died from an overdose in 2016.

“We want every community member to be able to recognize who’s at risk for an overdose, to recognize signs and symptoms of an overdose, and if someone in your orbit is at risk for an overdose, we want you to know about, to carry and to know how to administer naloxone," Surgeon General Jerome Adams said during a tour of the Northern Kentucky Health Department April 9 in Florence.

Adams mentioned the challenges of the stigma that surrounds addiction, and referred his younger brother, Philip, who he said has struggled from a substance-use disorder for years and is imprisoned for crimes he committed to feed his addiction, Terry DeMio reports for the Cincinnati Enquirer.

"We need to see addiction as a chronic disease, not a moral failing," Adams said.

Adams called on the "medical community to step up" and to learn to recognize "who is at risk and to be able to intervene, or to refer where appropriate," Don Weber reports for Spectrum News.

He also said that while health-care providers are "doing a much better job of not over-prescribing," this often causes people to shift over to illegal heroin, "and there's a separate heroin epidemic within the opioid epidemic." Adams urged connecting people to evidence-based treatment, including the use of medication-assisted therapies, like naltrexone, methadone and buprenorphine.

Adams said he is well aware that many people say administering naloxone to revive an overdose victim is enabling further drug use, but he disagrees with them, Weber reports.

"I say that we are enabling recovery," Adams said. “I’ve heard from four different individuals this morning who were resuscitated each multiple times with naloxone. One is out sharing the good news about his fate, another one has two children who now have a father because of naloxone.”

Adams praised Kentucky for having more than 50 syringe exchange programs to combat the infectious diseases that come with intravenous drug use, like hepatitis C and HIV. He encouraged all communities to "have a conversation" and consider having one.

The Kentucky Office of Drug Control Policy's website KyStopOverdoses allows you to search for pharmacies that carry naloxone by city, county or ZIP code. The cost varies, and insurance plans often cover it but may require a co-payment. Some health departments provide naloxone training and offer kits for free. You do not need a prescription for naloxone in Kentucky.

Beshear joins 15 other Democratic attorneys general in seeking to block lawsuit aimed at striking down Affordable Care Act

Attorney General Andy Beshear has joined with 15 of his Democratic counterparts in other states seeking to intervene a lawsuit aimed at striking down the Patient Protection and Affordable Care Act.

The suit, filed in a Texas federal court by 18 attorneys general and two governors, claims that the 2010 law is unconstitutional because last year Congress eliminated the law's penalty for failing to purchase health insurance, known as the individual mandate.

The would-be interveners argue that a successful suit "would devastate the nation’s health care system, causing millions of people to lose access to quality, affordable insurance and cost the intervening states billions of dollars in federal funding," said a press release from Beshear's office.

Beshear said Kentucky would lose $49.7 billion in federal funding for its Medicaid expansion, which covers 493,000 people, and subsidies for the 90,000 people who bought Obamacare insurance plans, through 2028.

“Hundreds of thousands of Kentuckians are at risk of losing their health care coverage, many of whom have coverage for the first time,” he said in the release.

All the attorneys general who filed the suit are Republicans. Beshear is joined by other Democratic attorneys general in California, Connecticut, Delaware, Hawaii, Illinois, Massachusetts, North Carolina, New Jersey, New York, Oregon, Rhode Island, Virginia, Vermont, Washington and the District of Columbia. Beshear's release did not note any party affiliations. 

Op-ed: Pharmacy benefit managers exclude diabetes medications and supplies from coverage more than any other category

As insurers continue to exclude many diabetes-related medications and supplies from coverage, children with diabetes could be "saddled with lifetimes of exorbitant out-of-pocket costs," Stewart Perry and Jeff Hitchcock write in an op-ed for the Lexington Herald-Leader.

Perry, of Lexington, is the parent of a child with diabetes and the past national chairman of the board of the American Diabetes Association. Hitchcock is founder and president of Children with Diabetes and a member of the Doctor-Patient Rights Project.

Kentucky ranks fifth among all states in the rate of diabetes, with over 13 percent of the state's adults diagnosed with the disease.

The authors say that the growing number of Kentuckians with diabetes could be one of the reasons pharmacy benefit managers -- who act as middlemen between patients and drug companies -- are excluding so many diabetes-related medications and supplies from being covered. They note that these exclusions are "more than any other treatment category."

Perry and Hitchcock write that a Doctor-Patient Rights Project study found that in the last four years, "the number of diabetes-related medications or supplies excluded from coverage by the nation’s two largest PBMs (CVS and Express Scripts) has increased by almost 80 percent, the only treatment category where the PBMs consistently increased the number of excluded medicines every year."

"Diabetes-related treatments now account for one out of every five medicines excluded from coverage by these PBMs," they write.

The idea behind these exclusion lists is to compel patients to use less expensive treatment choices, "falsely assuming that every patient with diabetes will respond the same way to every treatment choice," the authors write. The study found that many patients who are asked to switch to a new medication choose to pay out-of-pocket for the treatment their doctor originally prescribed, rather than switch to the insurer’s preferred drug.

The authors of the op-ed add that other studies show that when patients have to pay more for their medications, they are more likely take the drug incorrectly by splitting pills or skipping doses to make it last longer. They add, "forced non-medical switching may even backfire as a cost-saving strategy for insurers" because failure to use medication as prescribed makes treatment less effective.

Such failure "accounts for up to 10 percent of hospitalizations, 25 percent of nursing home admissions and as many as 125,000 premature deaths annually, according to a study in the Journal of Managed Care & Specialty Pharmacy," they write. "As a result, it contributes an extra $100 billion to $289 billion in medical expenses each year, at least some of which fall to insurers to pay."

Perry and Hitchcock say fully covering prescribed treatments would allow parents to use the most effective medications for their children, and allow the medications to be used appropriately. They conclude: "The cost savings generated by letting doctors drive treatment decisions more than compensates for the higher pharmaceutical costs."

Ky. nursing leaders call for a full-time nurse in every school to keep students safe and healthy, and therefore able to learn

Kentucky's nursing leaders are calling on state lawmakers to recognize the vital role school nurses can play "to support student learning in a safe and healthful environment," and are urging them to find "innovative funding" to put a nurse in every school.

"The school nurse is in a prime position to lead this effort but must be present in every school," lead author Kathy K. Hager,  president of the Kentucky Nurses Association, writes in an op-ed for the Lexington Herald-Leader. Only 54 percent of Kentucky's secondary schools have a full-time registered nurse, she notes.

Hager says that nationwide, an estimated 27 percent of students have a chronic health condition and 17 percent experience a mental-health issue each year. In addition, she notes that students are struggling with bulllying, drug-use and gun violence issues.

"In this climate of school violence, along with children’s increasing struggles with physical, behavioral and mental health challenges, much is being debated regarding strategies and resources to support student learning in a safe and healthful environment," Hager writes. She argues that a nurse in every school is the best way to address these needs.

Hager notes that daily access to a full-time nurse as part of the strategy to improve health and safety in schools is supported by the American Academy of Nursing and the American Academy of Pediatrics; the World Health Organization has also identified school health services as an important strategy toward this end.

A recent Academy of Nursing brief on this issue said, “School nurses deliver skilled health care to students, provide referrals to other providers, and assist families in gaining access to specialized care. Yet, despite these undisputed benefits, many schools do not have daily access to a full-time school nurse due to inadequate funding and lack of integration of school health services to the broader health-care system.”

Kentucky adults are overwhelmingly supportive of a law to require a nurse in every school, with 92 percent of them in the latest Kentucky Health Issues Poll saying they supported such a measure.

"We are fully aware of the current budget constraints in Kentucky; however, for the health and welfare of our Kentucky children, we must find innovative funding sources to place a nurse in every school as part of a comprehensive health and education system," she writes. "Contact your local school board and legislators and be the voice your children need. For the health, safety and welfare of our children, every Kentucky school needs a nurse and a comprehensive school health-care plan. Kentucky children are counting on you."

Patricia V. Burkhart, Carol Komara and Lois Davis, who represent the nurses association’s Kentucky School Nurse Committee, also contributed to the the op-ed.

Many health-related bills have passed and two have been vetoed; many still wait on the governor; here's a roundup

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Health-related bills passed by Kentucky lawmakers this year address transparency, access to care, the opioid epidemic, teen suicide, organ donation, abortion and sex education, among other topics. Gov. Matt Bevin has signed several into law, but many await his signature or veto and a possible override vote when legislators return Friday, April 13.

Legislators may also meet April 14, the last possible day. They could pass additional legislation, but it would be subject to a veto without the opportunity for an override.

Health bills vetoed

Opioids and Hospice: HB 148, sponsored by Rep. Addia Wuchner, R-Florence, would shift ownership of controlled substances from deceased hospice patients to hospice for disposal. Bevin's veto message recognized the "well-meaning" intent of the bill, but said the bill was illegal because according to the U.S. Drug Enforcement Agency, "transferring unused controlled substances to home health or hospice programs would be illegal" because the "DEA does not register hospice providers" and the DEA does not allow for this process. He also wrote that the Department for Public Health, which was to be used as a reporting agency for individuals who refused to shift ownership of their drugs, "has no statutory or regulatory authority over hospice, home health or controlled substances."

Rare Disease Advisory Council: SB 7, sponsored by Sen. Julie Raque Adams, R-Louisville, would establish the Kentucky Rare Disease Advisory Council. The governor's veto message called the intent of the bill "laudable," but said it was "an unnecessary expansion of bureaucracy." He added that the bill does not provide any funding for the council, and that the state health department "does not currently have the expertise to support activities in the specialized field of rare diseases."

Bills on the governor's desk

State guardianship program: HB 5, sponsored by Rep. Daniel Elliott, R-Danville, more clearly defines state guardianship for disabled adults. It adds a provision to allow jury trials to be waived if all parties agree that it is in the best interest of the person being considered for guardianship, and a trial would be granted if requested. Kentucky is one of the only states that still required a jury trial for guardianship.

Pharmacists and medication-assisted therapies: HB 246, sponsored by Rep. Danny Bentley, R-Russell, creates a pilot program to allow community pharmacists to provide medication-assisted therapy for substance abuse, as members of a community team of "wrap-around services." The program would be implemented by the state as funds are available. Bentley, a pharmacist, has said this program will increase access to MAT and could be a model for the nation.

Pharmacy benefit managers: Senate Bill 5, sponsored by Sen. Max Wise, R-Campbellsville,  would put the Medicaid program in charge of reimbursement rates for pharmacists. Rates are now set by pharmacy benefit managers, hired by managed-care organizations. The bill also sets reporting requirements for PBMs and MCOs and the $1.7 billion they get annually for pharmacy benefits. It also would allow the Medicaid program to approve contracts and fees between MCOs, PBMs and pharmacists.

Pharmacy transparency: HB 463, sponsored by Rep. Michael Meredith, R-Brownsville, would prohibit pharmacy benefit managers from requiring clients to make a co-payment that is higher than a lesser cash-payment amount, and keep PBMs from penalizing a pharmacy for telling patients if that option is available. HB 463 is often referred to as the "clawback" bill, referring to the practice of the PBM "clawing back" the difference between the higher co-pay and the lower price of the drug.

Guidelines for opioid disposal: SB 6, sponsored by Sen. Alice Forgy Kerr, R-Lexington, would require pharmacists to inform customers how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal, or provide on-site disposal. More than 70 percent of all opioid addictions result from misuse of prescription drugs.

Abortion: HB 454, sponsored by Wuchner, would prohibit the most common kind of second-trimester abortion, known as a D&E, or dilation and evacuation. Wuchner says the bill is necessary for the "humane treatment of an unborn child, to protect that unborn child from dismemberment." Similar legislation has been challenged in other states and was found unconstitutional in Texas.

Pregnancy and hepatitis C tests: SB 250, sponsored by Adams, would require all pregnant women to be tested for hepatitis C, and put test results in' the mother's records and the child's, with recommendations that the child be tested at 2 years if the mother tests positive. Hepatitis C can be transmitted from mother to baby during childbirth, and most new cases of hepatitis C are a result of intravenous drug use. Laura Ungar of the Courier Journal reports that in 2014-2016, one in 56 Kentucky births were to mothers with a history of hepatitis C; as many as 55,000 babies are born in Kentucky each year.

Sex education and abstinence: SB 71, sponsored by Sen. Steve Meredith, R-Leitchfield, would require the inclusion of abstinence only education in any sex-ed classes taught in Kentucky. Comprehensive sexual health education standards are currently being reviewed by the state education department.

Bills that will become law

Medicaid manged care: House Bill 69, sponsored by Rep. Ken Fleming, R-Louisville, improves the Medicaid managed care organization credentialing and enrollment process and requires monthly reports that show claims, denials and grievances. Health-care providers have long asked for such changes to make MCOs more accountable.

Malpractice lawsuits: HB 4, sponsored by Wuchner, will keep doctors' reviews of other doctors from being used in malpractice lawsuits. Kentucky is the 49th state to adopt such a law. Lawmakers have tried to pass similar legislation for years. Unlike previous bills, this one has language like federal law, saying providers can claim the privilege only for safety and quality.

Substance-use programs: HB 124, sponsored by Wuchner, calls for a comprehensive review of all state programs for substance-use disorders, and requires the state to pay for and license only those that follow nationally recognized, evidence-based protocols. An amendment was added to allow the Department of Corrections to buy long-acting medication for substance-use disorders that are resistant to diversion, including unspecified new ones not yet available.

Autism coverage: HB 218, sponsored by Rep. Bart Rowland, R-Tompkinsville, requires all health plans to cover autism and removes dollar and age limits. It also modifies the definition of "autism spectrum disorder" and ties it to the most recent diagnostic tool. It is estimated that one in 68 people nationally is on the autism spectrum, with about 69,000 of them in Kentucky. April is World Autism Awareness Month. The law will take effect January 1, 2019.

Online eye exams: HB 191, sponsored by Rep. Jim Gooch, R-Providence, is Kentucky's first law regulating online eye exams and prescriptions. It requires that a patient be 18, give a medical history, and have had an in-person eye exam in the last two years. It also bans them from getting contacts for the first time through an online exam. After much debate, the bill was amended to remove a rule for "simultaneous" consultation between the online provider and their patients, which critics said would have limited access to eye care and tele-health technologies.

Organ donation: HB 84, sponsored by Rep. Lynn Belcher, R-Marion, requires coroners and medical examiners to contact the Kentucky Organ Donor Affiliates if they know that a decedent wished to be an organ donor. Current law only requires hospitals to contact KODA when a documented would-be donor dies. It is called "Courtney's Law," for Courtney Flear of Princeton, who was killed in an automobile accident in 2015; due to the current law her organs were not donated despite her wishes.

Veterans with brain injuries: HB 64, sponsored by Rep. Stan Lee, R-Lexington, allows veterans with traumatic brain injuries to get hyperbaric oxygen treatment. The treatment is regularly prescribed to veterans with a TBI, but many don't get it because it is considered "off-label" treatment not covered by insurance. The law will allow veterans access to the treatment, but does not require insurance to cover it.

Disabled parking: HB 81, sponsored by Rep. Jerry Miller, R-Louisville, establishes new rules for disabled parking placards, limiting eligible individuals or organizations to one free permanent or temporary placard and requiring $10 for each additional placard. It also replaces hand-written placards with ones that are more difficult to alter. Placards can be given for up to six years for those who qualify, and the process has been updated to make it easier to get a temporary one. Placards will now be issued for the applicant, not the applicant's vehicle, and will expire in the applicant's birth month. It also expands who can issue a statement of need for a placard to physician assistants, physical therapists and occupational therapist. Miller said the bill is needed because the number of them grew from 32,600 to 298,000 after the state removed fees 10 years ago.

School suicide prevention: HB 30, sponsored by Rep. Regina Huff, R-Williamsburg, requires one hour of "high-quality" suicide-prevention training in middle and high schools beginning with the 2018-19 school year, and every other year thereafter. The training is be in person or video. The bill removes the current requirement for two hours of self-study for suicide prevention. It was reported in the House Education Committee that Kentucky had more than 600 suicides among 10- to 24-year-olds in 2005-2013.

Ambulance cost transparency: HB 176, sponsored by Rep. Rob Rothenburger, R-Shelbyville, to require ambulance services to post a comprehensive, up-to-date fee schedule, and to provide a copy to a beneficiary  upon request at the time of service.

State guardianship program: House Joint Resolution 33, sponsored by Elliott, creates a pilot called Working Interdisciplinary Networks of Guardianship Stakeholders, or WINGS, to examine how the state's guardianship program is working and to identify any needed changes. The state is the guardian for 4,448 people, and social workers have 65 to 70 cases apiece, about three times more than recommended by national guidelines.

Bills that could still pass

Telehealth bill: SB 112, sponsored by Sen. Ralph Alvarado, R-Winchester, is a telehealth bill aimed at increasing access to care and saving the state money by requiring the state to develop telehealth policies, including a reimbursement model, with similar expectations for the public insurance market. This bill has been posted for House passage but with an insurance-company floor amendment filed by Gooch to remove a provision that says telehealth visits have to be paid for at same level as regular visit, unless otherwise negotiated.

Fertility coverage: SB 95, sponsored by Kerr, would require health insurers to cover standard fertility preservation services for patients who have become infertile by means of surgery, radiation, chemotherapy or any other medical treatment affecting reproductive organs and processes.

Palliative care: SB 149, sponsored by Adams, would establish the Palliative Care Interdisciplinary Advisory Council, which would make recommendations on how to improve and expand palliative care and educate patients about their options.

Kentuckians' enrollment in Affordable Care Act plans is 10.4% higher than 2017, 4% below 2016; county data available

Over 10 percent more Kentuckians signed up for Obamacare health insurance in the recent enrollment period than the one a year ago, contrary to the national trend for enrollment under the Patient Protection and Affordable Care Act.

The Kentucky enrollment was 89,569, a 10.4 increase from last year's 81,155, and just 4 percent under the 93,666 who enrolled in 2016. That was the last year before the administration of Gov. Matt Bevin moved enrollment to the federal HealthCare.gov website.

Nationally, Obamacare enrollment was down 4.2 percent, to 11.75 million from 12.7 million in 2016 and 12.2 million in 2017, according to federal reports compiled by ACAsignups.net.

Data from the Centers for Medicare and Medicaid Services show that 27,598 of the Kentucky enrollees, or 31 percent, were new to Obamacare. Of the 61,971 who re-enrolled, 28 percent were re-enrolled automatically; the rest were active re-enrollees, usually switching plans from last year.

Most of those switched from a typical "silver" plan to a cheaper "bronze" plan with higher thresholds and co-payments. About five in eight active re-enrollees switched plans; that doesn't count those who "crosswalked" to a similar plan from one that was changed or eliminated.

About 76 percent of Kentuckians on Obamacare have their premiums subsidized by "advance premium tax credits," granted upon enrollment, and 42 percent are getting cost-sharing reductions that are gauged by income.

The average monthly premium for Obamacare insurance in Kentucky is $544, but after the tax credit it is only $201. That average includes people who don't get financial assistance and have seen major increases in their premiums.

Among the Kentuckians who are getting the tax credit, the average credit is $455, and the average monthly premium for those receiving a credit is $124. The national average is $89 a month.

Of the 135,606 Kentuckians who applied for coverage on 91,240 applications, 76,794 were found to be eligible for tax credits, and another 25,914 were found to be eligible for free coverage through Medicaid or the Children's Health Insurance Program. Medicaid covers 1.44 million Kentuckians, about 493,000 of them under the program's expansion under the Affordable Care Act.

For county-by-county data on Medicaid, in an Excel spreadsheet, click here. For a spreadsheet of county-by-county enrollment in ACA plans, go here. A spreadsheet of ACA enrollment by ZIP code is also available, from a page on the CMS website.

Feds will nearly double funding for research on addiction and opioid abuse; detailed at Rx Drug Abuse and Heroin Summit

The National Institutes of Health said at the National Rx Drug Abuse and Heroin Summit April 4 that it will increase funding for research on addiction and opioid abuse to $1.1 billion this year.

Funding for the initiative, called Helping to End Addiction Long-term (HEAL), comes from Congress's $500 million increase in NIH funding, Laura Ungar reports for the Louisville Courier Journal.

The money will be used to focus on best methods treatment and prevention, and the search for non-addictive therapies for pain. "The aim is to stem a crisis that devastates millions of families and kills 115 Americans every day," Ungar writes.

NIH Director Dr. Francis Collins made the announcement at the seventh annual summit that hosted more than 3,000 experts in addiction, medicine and law enforcement April 2-5 in Atlanta.

“We all gather here not to think about how hard it is (to tackle the epidemic), but what we can do,” Collins told the crowd. “All of us hope to see this opioid crisis come to an end. But we’re all about action.”

Collins said his agencies are working on initiatives to determine which patients are more likely to develop chronic pain after surgery and are looking at genetic and social factors that put patients at risk of opioid addiction.

In addition, they are looking at non-drug therapies for pain management, pursuing public-private partnerships to develop new non-addictive pain medicines, looking at options for medication assisted therapies for addiction and evaluating treatments for infants born dependent on drugs.

“We also need to know what happens to these children” as they grow up, Collins said.

On April 5, Surgeon General Dr. Jerome Adams issued an advisory urging more Americans to carry the opioid overdose-reversing drug, naloxone, sold under the brand name Narcan. This was the first surgeon-general advisory in 13 years; the last one focusing on alcohol use during pregnancy, Ungar Ungar reports for USA Today. 

"Surgeon-general advisories are issued when there is a major health problem and a need for a call to action," Adams told Ungar. "One of the things we're trying to do is help the public understand that we're losing a person every 12.5 minutes from an opioid overdose, and . . . over half of these overdoses are occurring at home.

"So we have firefighters, we have EMTs, we have police officers carrying naloxone, but we can save so many more lives if we can empower the citizens, the loved ones, the family members to carry naloxone."

In Kentucky, specially trained pharmacists can dispense naloxone without a prescription. It’s also available through the Kentucky Harm Reduction Coalition. More than 1,400 Kentuckians died from drug overdoses in 2016.

Adams and other health officials rejected criticism that naloxone enables addicts, Ungar reports. They compared it to cardiopulmonary resuscitation (CPR) for the heart and lungs, or the EpiPen, a device for injecting epinephrine to reverse symptoms of allergic reactions.

"We don't give you one shot at a lifesaving intervention and then just leave you," Adams said.
"We treat you as if you have a problem that is going to take a long time to definitively fix. Addiction's a chronic disease. It's not a moral failing and there's not going to be a magic fix. It's important that we use naloxone as a bridge to definitive treatment and long-term recovery."

Ungar notes, "Nationally, an estimated 2.1 million people struggle with opioid addiction, and opioid overdose killed more than 42,000 in 2016 alone."

On the summit's first day, U.S. Rep. Harold "Hal" Rogers of Eastern Kentucky's Fifth District received the summit's inaugural Beacon of Hope Award for his efforts to fight drug abuse in the district. The award will be named after Rogers moving forward, Tom Valentino reports for Addiction Professional.

The summit began in 2012 under the leadership of Operation UNITE, which Rogers founded in 2003 to "rid communities of illegal drug use through a comprehensive approach that includes educating youth and the public, coordinating substance-abuse treatment and providing support for families and friends of substance abusers," says the Summit's website. UNITE, which stands for Unlawful Narcotics Investigations, Treatment and Education, Inc., serves 32 counties ion Eastern and Southern Kentucky.

Rockcastle Regional Hospital in Mount Vernon expands again to provide long-term care for more ventilator-dependent patients

The hospital has expanded across a Mount Vernon street to make room for more respiratory residents.

Rockcastle Regional Hospital in Mount Vernon is a national example of how a rural hospital found a new business model to serve people with specific needs.

The hospital is one of the few places in Kentucky that primarily provides long-term care to ventilator-dependent patients, Angela Reighard reports for Lexington's WKYT-TV.

"We're sort of a destination for ventilator care just because we do such a good job weaning people," John Lambert, the hospital's director of development, told Reighard. "We've had patients here from 26 different states."

At a time when dozens of rural hospitals have closed and others have merged with larger hospital groups to make ends meet, Rockcastle Regional has found a national niche.

The hospital recognized a need for long-term care for ventilator patients almost 40 years ago. It opened its first long-term care unit with 32 beds and added 28 more 12 years later. It recently completed an expansion of its Respiratory Care Center, which has 127 residents.

As part of the expansion, the hospital added technology to improve the quality of life for the patients staying there, Reighard reports. For example, 25 patients have received a Google Home device, which allows them to get information and music through voice control.

Teddy Fulton, a 10-year resident who sustained his injury from a trampoline accident when he was 16, told Reighard that he uses the device to listen to music.

"I had an iPod and people had to come turn the stations for me and stuff, but when I got the Google Home, I can play the music I want to, turn to any song I want to," Fulton said.

Reighard also notes Joe Pursiful, a two-year resident with amyotrophic lateral sclerosis (Lou Gehrig's Disease). Pursiful can no longer speak, but is able to communicate through a Tobii device, which speaks for him by tracking his eye movement.

"This device was provided by donations from Team Gleason, an organization started by former New Orleans Saints player Steve Gleason," Reighard reports. It allows him to type sentences to describe what he wants and needs, and to also have a little fun.

"Since receiving my device I have gotten back a little bit of freedom," Pursiful said. "I can still communicate with people and let them know what I need. I just do it a little different."

The hospital eventually hopes to make it so patients can control their lights and temperatures on their own. Lambert told Reighard, "It's almost like, there's not a biological cure but there's a technological cure."

Click here to learn about donation opportunities for the hospital's ventilator patients.

Legislature sends governor two Medicaid drug measures, one to help independent pharmacies and the other to help consumers

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to allow pharmacists to tell their patients the least expensive way to pay for their medications and one to put the state back in direct charge of its Medicaid drug program have received final passage and are on the desk of Gov. Matt Bevin.

Sen. Max Wise

A revised version of Senate Bill 5, sponsored by Sen. Max Wise, R-Campbellsville, would put the Medicaid department in charge of setting the reimbursement rates for pharmacists. These rates are now set by pharmacy benefit managers, hired by the Medicaid managed-care organizations that handle Medicaid for the state -- but with no accountability to state Medicaid officials.

“The Kentucky legislature has spent an inordinate amount of time over the past several sessions of the General Assembly trying to play the role of policeman between PBMs and pharmacists,” Wise told the Senate. “The House committee substitute gives the Kentucky Medicaid department clear authority to police pricing terms and contracts.”

Wise has said he filed the bill because PBMs are paying independent pharmacies such low fees for dispensing prescriptions that many are at risk of closing. The fees are as low as 85 cents per prescription. The Centers for Medicare and Medicaid Services says it should be around $10.64, plus the cost of the drug being dispensed.

The pharmacy chain CVS has a PBM subsidiary that contracts with four of the five managed-care organizations. The chain has asked some independent pharmacies to place a value on their businesses and consider selling.

The original bill called for independent pharmacists to be paid this amount, but the Cabinet for Health and Family Services said this mandate would cost $36 million a year. That prompted the House to change the bill to say the Department for Medicaid Services would determine reimbursements.

The bill also allows the department to regulate contracts between the managed-care organizations, PBMs and pharmacists; requires more transparency in how the PBMs spend the $1.7 billion a year they get to process prescriptions; and gives the department and the Department of Insurance authority to penalize the MCOs and PBMs for noncompliance.

The amended version of SB 5 passed the House 97-0 on March 20 and passed the Senate April 2 by a 37-0 vote.

Rep. Michael Meredith

House Bill 463, sponsored by Rep. Michael Meredith, R-Brownsville, would prohibit PBMs from requiring clients to make a co-payment that is higher than an optional cash-payment amount, and keeps PBMs from penalizing a pharmacy for telling patients if that option is available.

The practice of charging a co-pay that is higher than the full cost of the drug is called a "clawback," because the PBM "claws back" the extra money from the pharmacy. For example, if a patient's co-pay is $10, but the drug costs only $5, the PBM may require the pharmacist to charge $10 and not say it can be bought more cheaply; the PBM pockets the difference.

A recently published study at the University of Southern California, using data from 2013, found that customers overpaid for their prescriptions 23 percent of the time, with an average overpayment of $7.69, which totaled $135 million during a six month period, Kaiser Health News reports.

Meredith told the House that the PBMs support HB 463. It passed both houses without opposition.

Lexington bans tobacco, including smokeless, at city ballfields

By Melissa Patrick
Kentucky Health News

Lexington's 56 city-run baseball parks, including Whitaker Bank Ballpark where the Lexington Legends play, are now tobacco-free. The city prohibits use of cigarettes and smokeless tobacco products at city fields, including dugouts, bleachers, spectator areas, concession areas and restrooms.

Andy Shea, president and CEO of the Lexington Legends;
Ben Chandler, Foundation for a Healthy Ky. president;
and Lexington Mayor Jim Gray. Shea and Gray received
the foundation's Healthy Kentucky Policy Champion award.

"This important move will create a healthier and safer place for the thousands of Legends fans who come to the park each season," Mayor Jim Gray said at the announcement.

Gray noted that Lexington passed Kentucky's first city-wide smoking ban nearly 15 years ago and saw "almost immediate results," including fewer asthma-related emergency room visits and a "big" drop in the smoking rate.

"For the kids and families coming to the parks, we are taking the next step as a city," he said.

This effort is part of a nationwide movement to break the longstanding connection between baseball and smokeless tobacco, often used by baseball players.

The latest Youth Risk Behavior Survey found that 10.6 percent of Kentucky high schoolers used smokeless tobacco in 2017, compared to 5.8 percent nationally in 2016. Many more boys than girls use the product in Kentucky, 17.2 percent versus 3.1 percent.

It's a habit that comes with serious health risk, including oral, pancreatic and esophageal cancer. It can also lead to nicotine addiction, increased risk for death from heart disease and stroke, and diseases of the mouth.

Amy Barkley, regional director,
Campaign for Tobacco-Free Kids

"We applaud the Lexington Legends for taking a strong stand against tobacco and for kids, by making Whitaker Bank Ballpark 100 percent tobacco-free,"said Amy Barkley, regional director of the Campaign for Tobacco-Free Kids. "By taking tobacco use completely out of the game here in Lexington, it sends a strong message to kids that our national pastime should be about promoting a healthy and active lifestyle, not a deadly and addictive product."

The Campaign for Tobacco-Free Kids' "Knock Tobacco Out of the Park" program has been working with professional baseball for several years to "take tobacco out of the game of baseball for good," Barkley said.

Chewing tobacco has been banned among players in minor league baseball at ballparks and during team travel since 1993, but so far only 14 out of 30 Major League teams have similar policies, said Barkley. She added that the last collective bargaining agreement prohibits any new player in Major League ball from using tobacco.

Andy Shea, president and CEO of the Lexington Legends, said in a news release, "We are very proud to be one of the first Minor League Baseball facilities in the country to go tobacco-free."

Foundation for a Healthy Kentucky CEO Ben Chandler Chandler gave Shea and Gray a Health Policy Champions award from the foundation. He called the announcement "an important signal that we're sending here in the commonwealth of Kentucky to everybody about the need to curb our use of tobacco here in Kentucky."