Huge grant fails to reduce ODs by 40%; does show a 9% drop over four states, saving an estimated 483 lives, but few in Ky.

The National Institues of Health’sNational Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration funded the study through the NIH HEAL Initiative.

By Melissa Patrick

Kentucky Health News

A four-state, $350 million research grant that included Kentucky fell far short of its goal of reducing opioid overdose deaths by 40% over four years, instead showing an estimated 9% drop in such deaths. 

"That translates into an estimated 483 opioid-overdose deaths that were averted in the communities that received the intervention," said Patricia Freeman, part of the HEALing Communities Study research team and an associate professor of pharmacy at the University of Kentucky.  

Another model, comparing those to communities to a control group of counties with similar charcteristics, showed a 15% average reduction in opioid-overdose deaths in the intervention communities, which Freeman said was "very close to reaching statistical significance."

"It's still consequential even though it didn't reach statistical significance," said Freeman. "An estimated 483 lives were saved. And just because it didn't reach statistical significance doesn't mean that it was not a meaningful public-health impact." 

In Kentucky, there was no real difference in the adjusted rate of opioid-related overdose deaths between the intervention counties and the control-group counties, with 59.8 deaths per 100,000 residents in the intervention communities and 59.3 per 100,000 in the control communities. 

The study compared the control and intervention communities for one year, July 2021 through June 2022. 

"In retrospect, I think people will say that the 40% was a very ambitious goal," said Freeman. The researchers in the paper said likewise, adding, "The trial may have been underpowered to detect substantially smaller yet clinically meaningful differences."

An underpowered study does not have a sufficiently large sample size to answer the research question of interest,"  says the National Library of Medicine. according to L.D. Case and W.T. Ambrosius in an article titled "Power and Sample Size," published in Topics in Biostatistics.

The study, published June 16 in The New England Journal of Medicine, found no differences in estimated opioid-overdose deaths among the four states, nor any statistical differences between urban and rural communities, by age, by sex or among racial and ethnic groups. 

The research paper identifies several unforeseen challenges that likely diminished the impact of the interventions. Those include the Covid-19 pandemic, which began just two months after the start of the study’s intervention, an increase in the prevalence of fentanyl in illicit drug markets, and a 10-month implementation period, which may have been too short for communities to fully implement and see the effects of their efforts, says a UK news release.  

The four-year study, launched in 2019, included 67 communities affected by opioid abuse, including 16 Kentucky counties. UK  received $87 million from the National institutes of Health for the study, the largest competitive award UK has ever received. 

The other participants were Boston Medical Center in Massachusetts, Columbia University in New York City and Ohio State University. 

The Kentucky counties where interventions were made were Boyd, Boyle, Clark, Fayette, Floyd, Franklin, Kenton and Madison. The control-group counties were Bourbon, Campbell, Carter, Greenup, Jefferson, Jessamine, Knox and Mason.

Freeman noted that the published study results don't reflect county-level data, but the impact of the interventions in all 67 communities.  

The interventions involved increasing education about overdoses; increasing overdose-prevention education and distribution of the anti-overdose drug naloxone; increasing access to and retention of medications to treat opioid-use disorder, including methadone and buprenorphine; safer opioid prescribing, dispensing and disposal practices; and reducing the stigma of addiction.

 

"Specific efforts in Kentucky included partnering with 145 organizations to distribute more than 40,000 naloxone units," the news release says. "Strategies to help people find and stay in treatment deployed 26 peer-recovery coaches and 16 care navigators and provided $411,848 in transportation support.

"Other activities included partnering with 35 pharmacies to install permanent medication-disposal drop boxes, which has resulted in the incineration of more than 6,500 pounds of leftover medication. Efforts to reduce stigma and increase awareness of treatment resources produced 64 communication campaigns, resulting in 73 million engagements."

The study's principal investigator, Sharon Walsh, a professor in the College of Medicine and College of Pharmacy and director of the UK Center on Drug and Alcohol Research, said in the release, “Our findings demonstrate that implementing these evidence-based practices through community-engaged strategies and partnerships can make a meaningful impact on combating overdoses, even amid the rapidly evolving opioid epidemic and unprecedented disruptions like the Covid-19 pandemic,”  

Freeman said researchers are continuing to analyze the data to look at the impact of each strategy used in the study, and have written a paper that is under peer review, looking at how naloxone distribution changed in the intervention and control communities.

She said they will also continue to analyze the impact of the interventions on non-fatal overdoses, the impact on overdoses that involved opioids and other substances, since this study was specific to opioids, among other things.

Also coming are results from the control communities, which received the interventions after the comparisons between the control communities and intervention communities were complete.

"We'll be trying to really understand what were the strategies that were the most impactful in our communities," Freeman said. 

Looking forward, Freeman said she thought Kentucky could see some long-term benefits from this study because of the infrastructure, technical assistance and training that was set up with the agencies and organizations to implement the study. "I'm interested to see what's going to be a longer term impact," she said. 

The good news is that Kentucky has experienced two years of declines in overdose deaths. In  2022, it was one of only eight states that saw a decrease in drug overdose deaths, and in 2023, it saw a 10% drop in such deaths, according to the state's Office of Drug Control Policy.

Updated 06/25/24: This article has been updated to reflect the correct attribution for the definition of an "underpowered study" to be  L.D. Case and W.T. Ambrosius in an article titled "Power and Sample Size," published in Topics in Biostatistics.

Coleman details $12 million in opioid grants, says his opposition to syringe exchanges is greater if they don't have one-to-one rule

Attorney General Russell Coleman talks to DV8 Kitchens
owners Rob and Diane Perez. DV8 Kitchens is getting
one of the prevention grants. (Photo by Melissa Patrick)

This story has been updated. 

By Melissa Patrick
Kentucky Health News

Attorney General Russell Coleman issued details Thursday of more than $12 million in grants from the state's opioid settlements for prevention, enforcement, treatment and recovery.

One of the grants will expand a syringe exchange, and was not supported by Coleman's appointees to the commission. He confirmed at an event Thursday that he opposes the exchanges.

"I'm extremely concerned that needle exchange further perpetuates drug use, and it will not be supported by me or this administration," he said in response to questions at an event he held to highlight the grants.

Coleman said the 51 grant recipients, chosen from 160 applicants, represent "bold ideas" aimed at trying to "save lives and tackle this crisis," with a focus on the three-legged stool of prevention, treatment and enforcement.

“We’re building programs and services that help Kentuckians for the next generation,” he said.

The announcement was made at DV8 Kitchens in Lexington, which employs people in recovery and is getting a $151,730 prevention grant to establish an employee-success mentorship program. 

“By connecting those in recovery with meaningful employment, we can give them a second chance at success,” DV8 owner Rob Perez said in a news release from Coleman's office. 

At the event, Perez stressed that while DV8 is "for people," its success is also good for the community. "Every time one person doesn't return back to addiction, we saved $37,000 as a community," he said.

Coleman's office oversees the Kentucky Opioid Abatement Advisory Commission, which the legislature created in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, which are being paid in installments. The commission has awarded $55 million in 110 grants, including $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in 11 pilot counties. 

Coleman said its important to remember where this settlement money comes from. “This is blood money, purchased by pain and devastation of families across this commonwealth, which is why we must be such stewards of this money,” Coleman said. "We're honoring those we've lost by our stewardship and how we use this money effectively." 

Half of the settlement monies go to the state and the other half goes to cities and counties. The commission is housed in the attorney general's office and is headed by Chris Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Syringe exchanges

Evans was one of the Coleman appointees who did not support a grant to the Boyle County Agency for Substance Abuse Prevention at at the June 4 commission meeting. In passing on the vote, he revealed Coleman's position on syringe exchanges.

The grant was approved by a majority vote. Coleman took office in January and has not yet made all of his five appointments; those members serve two-year terms. The other voting members are appointed by the University of Kentucky or serve by virtue of their office, including Coleman, who has designated Evans to hold his seat.

Two of the five positions that are appointed by Coleman were reappointed in June 2023, before he took office, with their terms expiring June 30, 2025. They included Karen Butcher and Von Purdy, both representing citizens at-large. Coleman appointed Darren "Foot" Allen, representing law enforcement, in February and that term will expire June 30, 2025. The other two positions to be appointed by Coleman expire at the end of this month. At this time Van Ingram, representing the drug treatment and prevention community, and Jason Roop, representing victims of the opioid crisis, fill those positions.

Asked if Coleman will make decisions about future appointments to the commission dependent on the person's view of syringe exchange programs, spokesperson Kevin Grout answered "No" in bold letters in an email.

Kentucky Health News asked Coleman if his lack of support for syringe exchanges for intravenous drug users, which are supported by research, could put a chilling effect on future applications for these programs.

He replied, "There's been no grant that has been blocked because of my personal opposition." He went on to say, "I don't support needle exchange. I support very robustly prevention, treatment and enforcement."

Asked if he had research to support his opinion, he said, "I'm a strong proponent of Narcan [an anti-overdose drug] and I'm a strong proponent of prevention. I'm very concerned that particularly when there's not a one-to-one ratio, a one-to-one return on needles that it is an enabler versus the harm reduction that we're actually seeking."

Some syringe exchanges have a one-for-one requirement, but regional health official Scott Lockard said in 2016 that most exchanges at that time used a "patient negotiation model," giving the user as many needles as they need for one week to assure they use a clean needle each time, often up to a capped amount.

"The goal is that they use a clean needle for each time they inject," Lockard said then. He said it is impossible to adhere to a strict one-for-one requirement. For example, he said users don't always keep up with their syringes or sometimes will tell you they are sharing them.

Coleman said he is a very strong advocate for wide distribution of Narcan, "given the nature of the threat we're seeing. . . . Narcan needs to be as ubiquitous as a fire extinguisher given this threat. But it always has to be Narcan plus a pathway to treatment, Narcan plus education. Because Narcan itself can be an enabler in some contexts. We want to make sure it's always coupled with treatment, coupled with prevention." 

Coleman also talked about his plans to build a statewide drug prevention program, with a goal of rolling it out this next school year. 

“We exist in a commonwealth where as little as one pill can and is taking our sons and our daughters,” he said. “But yet we lack a statewide prevention effort in our commonwealth. That will change.”

Coleman's office declined to release details of the grants until Thursday's event. Here's a summary of how the 23 new prevention grants will be used: 

Anderson County Agency for Substance Abuse Prevention, $171,100 for expansion of school-based prevention efforts and law-enforcement training.
Appalachian Research & Defense Fund (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
Big Brothers Big Sisters of the Bluegrass, $185,301 for a high-school mentoring program, to empower high school students to become positive role models for younger students.
Boys and girls Clubs of Kentuckiana, $200,000 for an innovative program aimed at opioid prevention for youth aged 6-18.
Carter County Public Library, $101,500 to hire resource specialists to prtovide greater access to recovery-oriented programming.
Covington Partners, $225,450 for prevention programming that includes out-of-school-time programs, school-based health services, mentoring, drug and violence prevention and family engagement.
Cumberland Trace Legal Services (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730 for the mentorship program, which will focus on removing barriers, supporting career-path development and job readiness while supporting recovery and wellness.
Girl Scouts of Kentucky Wilderness Road Council, $59,052 to launch the Building the Bridge to K-12 Girls Leadership Project, a community-based prevention program that focuses on increasing girls’ positive childhood experiences.
Jewish Family and Career Services, Louisville, $77,207 for enhancement of wraparound services for youth, to include opioid addiction screening and active prevention.
Legal Aid Society, $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.
Legal Aid of the Bluegrass, $125,000, same as above.
Mercy Health – Lourdes Hospital, $76,552 for a hospital-based, pharmacy-led tapering program, which slowly resudes doses of a drug over time to reduce withdrawal symptoms.
Operation Parent, $87,011 for prevention education of parents of 4th, 6th and 9th grade students in several Kentucky counties.
The Safety Blitz Foundation, $126,335 for a pilot version of The Coaches vs. Overdoses™ program, which addresses youth opioid misuse, the proliferation of synthetic opioids including illicit fentanyl, through prevention, education, awareness and community drug-disposal programming.
Scott County Sheriff’s Office, $91,847 for Drug Abuse Resistance Education in 5th and 9th grades.
Taylor County Schools, $208,824 for a school-based prevention program.
Three Rivers District Health Department, Owenton, $320,803 for a partnership with the Planet Youth program to implement a population-wide primary prevention process designed to take informed actions to increase protective factors, decrease risk factors and ultimately change the environment of children and youth.
University of Kentucky Research Foundation, $380,572 for development of prevention coalitions in Fayette County, educating 4th through 12th grade students and building community capacity and engagement around prevention efforts.
Operation UNITE, $751,850, for continuation and expansion of its Educate. Empower. Prevent. Program, which provides prevention training to students from 4th through 12th grades.
Wanda Joyce Robinson Foundation, Frankfort, $90,472 to start a youth substance intervention and prevention program that prevents substance use and abuse and promotes positive youth development and stronger families. The foundation helps children with incarcerated parents.
WestCare Kentucky, $100,404 for Camp Morilla, a free addiction prevention and mentoring day camp program for youth ages 9-12 and their families who have been impacted by family opioid use.
Young Men’s Christian Association of Greater Louisville, $248,487 for the YNOW Mentoring Program, which focuses on helping youth develop healthy drug-and violence-free lives.

Here is a summary of how the 28 new treatment and recovery grants will be used: 

Appalachia Regional Healthcare, $94,572 for expanding its peer recovery team so peer recovery coaches can be placed in four more hospitals.
Backroads of Appalachia, $167,025 for women in recovery with workforce training and employment opportunities.
Boyle County ASAP, $282,610 for expansion of its harm reduction program (including a syringe exchange), resilient-kids programming and case management efforts.
Celebrate Recovery Fairdale, $30,004 for weekly recovery meetings.
Center for Employment Opportunities, $255,109 for expansion of employment services for justice-impacted individuals in treatment or recovery.
Chrysalis House, Lexington, $227,273 for treatment for pregnant and parenting women.
Comprehend, Inc., $426,087 for opening a buprenorphine clinic in a community mental health center.
Eastern Kentucky Concentrated Employment Program, $450,000 for career and support services for people who are in recovery and comorbid polysubstance use who are interested in entering or re-entering the workforce.
Family Nurturing Center of Kentucky, $221,937 for services to children impacted by their caregiver’s opioid use and provides needed support to parents in recovery.
Family Scholar House, $245,110 for a five-step approach revolving around wrap-around services during and post-treatment to progress individuals from ‘crisis to stability’ targeting single parents, foster alumni, individuals facing reentry and post-secondary students.
Grin Grant, Lexington, $361,251 for expansion of dental restoration scholarships and peer support services and launch of a new recovery program.
Hope Center, $680,280 for in-patient, residential treatment for men.
Hope Springs Church, $50,462,Supports regular recovery support meetings and events.
Horsesensings, Inc., Bagdad, $115,219 for therapeutic job training in the horse industry and housing for those in recovery.
Isaiah House, $250,000 for recovery housing and job training aftercare opportunities for those in long-term recovery.
Kentucky Hospital Research and Education Foundation (Ky. Hospital Assn.), $250,000,Supports expansion of a program that ensures patients have 24/7 access to care.
Lake Cumberland Area Development District, $277,552 for case management and supportive services to individuals in recovery seeking to re-enter the workforce.
Life Learning Center, Covington, $498,500 for "a cutting-edge, technology-enhanced system designed to fill existing gaps in recovery services by providing continuous, real-time data, support and accountability."
Mercy Health-Marcum and Wallace Hospital, Irvine, $179,834 for recovery services for individuals with criminal justice involvement.
Natalie’s Sisters, $88,356 for expansion of services for women who have been sexually exploited or trafficked.
Northeast Kentucky Regional Health Information Organization, $331,997 for the Career Ready Workforce Project, which will focus prevention efforts on high-school students preparing to enter the workforce, individuals struggling with addiction ,and local agency staff members seeking to increase employable skills.
Ramey-Estep Homes, Rush, $222,801 for teen prevention-education programming, expansion of first-responder trauma-treatment programming and expansion of treatment and recovery access.
Recovery Café Lexington, $276,278 for expansion of recovery support model to a third location in Frankfort.
Transitions, Inc., Covington, $156,000 for expansion and enhancement of treatment services, as well as expansion of community education and prevention activities in the African American community.
Voices of Hope-Lexington, $538,021 to increase the quantity and quality of recovery support services for people in or seeking recovery.
Volunteers of America Mid-States, $664,587, for two recovery community centers in Lincoln and Pulaski counties.

Four Rivers Behavioral Health, Paducah, $232,251 for a mobile recovery support vehicle program that provides services to adults.
Young People in Recovery, Louisville, $301,440 for peer-led chapter and life-skills curriculum programs for people seeking recovery and a youth prevention program for middle- and high-school-aged children and their parents in five communities.

Letcher County backs off its plan to spend $125,000 in opioid-settlement money on an experimental therapy by Isaiah House

The Bridge device, which requires a prescription,  "sends

gentle electrical impulses . . . to the brain to reduce

withdrawal symptoms," its website says. (Photo from site)

By Sam Adams

The Mountain Eagle

The Letcher County Fiscal Court has reversed itself — at least for now — on whether it will give $125,000 of its opioid settlement money to a Christian-based drug-rehab center for an experimental electrical-stimulation therapy.

The court voted 4 to 1 with one abstention to table the contract with Isaiah House, a Willisburg-based nonprofit, until County Attorney Jamie Hatton can negotiate it. Hatton said the contract, brought to the court by jail minister Ted Adams of Letcher, does not allow the county to back out in case the treatment doesn’t work. “There’s nothing in there about termination for cause,” Hatton said.

Three of the five magistrates who had voted to give the money for the treatment expressed reservations this week, echoing Hatton that the contract needs to be negotiated, and saying the treatment is unproven, and at $5,000 per patient would allow only 25 patients to participate.

Adams was livid that the court did not approve the contract, saying the court voted to give the money before the NSS-2 Bridge device was approved by the federal Food and Drug Administration, and now wants to back out after it has been approved. “ It doesn’t make any sense,” he said.

The device, marketed by Innovative Health Solutions Inc. of Versailles, Ind., was approved under an FDA program called “the de novo premarket review,” which the FDA describes as “a regulatory pathway for some low- to moderate-risk devices that are novel and for which there is no legally marketed predicate device to which the device can claim substantial equivalence.”

Devices approved under that program are assessed to be low- to moderate-risk to patients, but it does not include an assessment of whether the devices have a therapeutic effect. A test included only 73 patients, 64 of whom self-reported decreased distress during opioid withdrawal after getting the device. Critics say the device has not undergone a randomized test to account for a placebo effect. While the company charges $600 per device, Isaiah House is asking the county for $5,000 per patient.

Adams said he could “bring in all the churches” where people have seen results of the device, but some magistrates said they would prefer that he brought in someone from Isaiah House and people who have used the device.

“The only thing is, I would like to talk to some people it helped,” District 5 Magistrate Benny McCall said. “I have talked to some people who said it didn’t do much for them, but I’d like to talk to some who say it has.”

District 1 Magistrate Jack Banks also questioned whether the device is worth the money the court would have to pay, saying it would only possibly help 25 people and that’s not guaranteed. Adams, however, criticized other programs the county has agreed to help fund, including the Harm Reduction Program run by the Kentucky River District Health Department. He said the court gave $50,000 to “buy needles for people to kill themselves.”

District 3 Magistrate Deb Collier responded, saying the needle exchange can’t be criticized because it prevents people who are addicted to drugs from passing deadly diseases such as AIDS and hepatitis to others by sharing needles.

Judge/Executive Terry Adams suggested the county wait to see how other patients in other counties that have agreed pay Isaiah House have progressed, but Ted Adams stopped him. “How many people are going to have die?” he said.

That also drew a response from Collier and from Banks, who said the court is watched about how it spends the opioid money and has a responsibility to spend it well. Banks said people are watching, and “if we spend $125,000 on this and it doesn’t work, how does that look on us?”

“How does it look to give $125,000 to CANE Kitchen?” Ted Adams asked.

Banks said CANE Kitchen is part of a rehab program that helps people get back to work, but Adams said that’s part of his ministry, too.

Collier, McCall, Banks, and Judge Adams voted to table the issue until Hatton can negotiate. Ted Adams left immediately when the vote was taken.

Cannabis users are at increased risk of severe Covid, study finds

Intensive care (Photo by Matt Miller, Washington University)

Kentucky Health News

Use of cannabis, commonly called marijuana, is linked to increased risk of serious illness for those with Covid-19. So says a study in the American Medical Association journal JAMA Network Open by researchers at the Washington University in St. Louis.

“There’s this sense among the public that cannabis is safe to use, that it’s not as bad for your health as smoking or drinking, that it may even be good for you,” Dr. Li-Shiun Chen, a professor of psychiatry and senior author of the study, said in a university news release.

“I think that’s because there hasn’t been as much research on the health effects of cannabis as compared to tobacco or alcohol. What we found is that cannabis use is not harmless in the context of Covid-19. People who reported . . . current cannabis use, at any frequency, were more likely to require hospitalization and intensive care than those who did not use cannabis.”

Cannabis use differed from tobacco smoking in one key measurement: survival. While smokers were significantly more likely to die of Covid-19 than nonsmokers — a finding that fits with numerous other studies — the same was not true of cannabis users, the news release said.

“The independent effect of cannabis is similar to the independent effect of tobacco regarding the risk of hospitalization and intensive care,” Chen said. “For the risk of death, tobacco risk is clear but more evidence is needed for cannabis.”

The researchers analyzed the health records of 72,501 people seen for Covid-19 at BJC HealthCare hospitals and clinics in Missouri and Illinois during the first two years of the pandemic. They "found that people who reported using any form of cannabis at least once in the year before developing Covid-19 were significantly more likely to need hospitalization and intensive care than were people with no such history," the release says. "This elevated risk of severe illness was on par with that from smoking."

The records contained demographic characteristics; medical conditions; use of substances including tobacco, alcohol, cannabis and vaping; and hospitalization, admittance to an intensive-care unit, and survival.

"Covid-19 patients who reported that they had used cannabis in the previous year were 80% more likely to be hospitalized and 27% more likely to be admitted to the ICU than patients who had not used cannabis, after taking into account tobacco smoking, vaccination, other health conditions, date of diagnosis, and demographic factors," the release says. "For comparison, tobacco smokers with Covid-19 were 72% more likely to be hospitalized and 22% more likely to require intensive care than were nonsmokers, after adjusting for other factors. These results contradict some other research suggesting that cannabis may help the body fight off viral diseases such as Covid-19.

Chen said, “Most of the evidence suggesting that cannabis is good for you comes from studies in cells or animals. The advantage of our study is that it is in people and uses real-world health-care data collected across multiple sites over an extended time period. All the outcomes were verified: hospitalization, ICU stay, death. Using this data set, we were able to confirm the well-established effects of smoking, which suggests that the data are reliable.”

The release says, "The study was not designed to answer the question of why cannabis use might make Covid-19 worse. One possibility is that inhaling marijuana smoke injures delicate lung tissue and makes it more vulnerable to infection, in much the same way that tobacco smoke causes lung damage that puts people at risk of pneumonia, the researchers said. That isn’t to say that taking edibles would be safer than smoking joints. It is also possible that cannabis, which is known to suppress the immune system, undermines the body’s ability to fight off viral infections no matter how it is consumed, the researchers noted."

“We just don’t know whether edibles are safer,” said first author Nicholas Griffith, MD, a medical resident at Washington University, who was a medical student therev when he led the study. “People were asked a yes-or-no question: ‘Have you used cannabis in the past year?’ That gave us enough information to establish that if you use cannabis, your health-care journey will be different, but we can’t know how much cannabis you have to use, or whether it makes a difference whether you smoke it or eat edibles. Those are questions we’d really like the answers to. I hope this study opens the door to more research on the health effects of cannabis.”

Fewer dying from overdoses, but advocates say Kentucky needs more people mentoring others through addiction and recovery

The availability of Narcan has helped reduce overdoses.
(Photo by Morgan Watkins, Louisville Public Media)

By Sylvia Goodman
Louisville Public Media

Shawn Nutter walks through The Healing Place’s men's facility in Louisville’s Russell neighborhood. He just completed the months-long recovery program, and now, Nutter’s working as a peer mentor for other people going through the same thing.

“You get six guys to get to intimately know, so you get to really understand what's going on with them,” Nutter said as he wound through the facility. “The things that could possibly help them or maybe hindered them in this process.”

He says he feels like he’s found his calling. Before coming to the Healing Place, Nutter said he worked as a chef, but now he wants to get certified as a peer support specialist.

“I want to know everybody that comes through here just because I like to know people,” Nutter said.

It’s a specialization sorely needed in the state. Earlier this month, Kentucky’s Office of Drug Control Policy released its annual report on fatal overdoses. For the second year in a row, overdose deaths went down (9.8 percent, more than triple the national decrease of 3%) but remain well above the levels the state saw before a 2020 spike rocked Kentucky.

And the numbers aren’t down across the board. Deaths continue to rise among Black Kentuckians, who have yet to see a decline since 2020. In 2018, 77 Black Kentuckians died of fatal overdoses, according to the report. Last year, 264 Black people in Kentucky did.

Gov. Andy Beshear declared the secind reduction in a row a win for the state while acknowledging there is more left to do. “We still have a long way to go, but celebrating success, celebrating doing better, celebrating having a better year is what gives us the strength to do even more,” he said.

Tara Hyde, CEO of Louisville's People Advocating Recovery, attributed the spike to the isolation of the pandemic and a drug supply heavily saturated with the powerful synthetic opioid fentanyl. “The fact remains that thousands of people have still lost their lives,” she said. “Thousands of families have been impacted.”

Hyde says advocates and service providers in the state know the work is far from over, especially in Black and Brown communities across the state. “We still are hesitant to really create more recovery supported spaces I think that's the re-energizing of saying, ‘I know that these systems are working, we just need to keep moving in that direction’.”

Improving outcomes for those in treatment

Recovery-supported housing, community centers and employment centers are popping up around the state to aid people as they leave treatment. Hyde said there are many examples across the state that her group has helped to foster, but services aren’t always centered in the communities that need them most.

Sharon Walsh, the director of the University of Kentucky’s Center on Drug and Alcohol Research, largely credits the decline in deaths to the much more widespread availability of the overdose-reversing drug naloxone, branded Narcan, which Walsh called a “miracle drug.”

Walsh said the 2020 spike in Kentucky was horrific and she can’t imagine how bad it would have been without the availability of naloxone, but she says there’s still work to be done the day after someone survives an overdose.

“You pick [naloxone] up at a fair, and then you have it in your pocket, and maybe you get to use it,” Walsh said. “That's incredible that you get to save someone's life. Does it make a longer term difference for that person whose life you saved? That's where the critical importance of linkage and education comes in.”

It’s an emphasis on those post-treatment spaces that could lead to declines in overall overdose numbers, Walsh said. She also emphasized the importance of working directly in the most impacted communities.

“People want to go to providers that look like them,” Walsh said. “If there aren't any providers that look like them, then that is also another barrier.”

A lot stands in people’s way of accessing that care, Walsh said. In rural communities, the closest treatment center can be hours away, or in majority Black areas with historic under-investment, medical care in general is often difficult to access.

“There's some very innovative programs going on with our colleagues out in Jefferson County that really can serve as models for other people to do, but they definitely need to be scaled up,” Walsh said.

There are several organizations in Kentucky that have boots on the ground going in to provide harm reduction and education to people directly — things like naloxone, fentanyl testing strips and hygiene supplies.

Abbie Kent is on the street team of the New Day Recovery Center in Winchester. She travels across the state, from urban areas to tent camps in rural Kentucky forests. Kent said the fact that she lived through to recovery and is able to provide resources to people breaks down barriers.

“They see me with a two-year-old track mark,” she said. “I was an IV drug user for the better part of 20 years, and my arm shows that when I come to people. They realize I'm not just some clinician.”

Kent said she is out there every day for people, going into overdose hotspots without judgment. “It's not about evangelizing, it's about planting the seed with people, and then making sure they have the resources to turn around and help somebody else,” she said, adding that she is able to build that trust only by being in those spaces and making herself a part of the community. Then when people need help, they know whom to ask.

Curious about new, popular weight-loss drugs? Here's a lowdown

Axios Visuals map adapted by Ky. Health News; click to enlarge

Editor's note: At the end of 2023 Kentucky led the nation in the percentage of state residents, 2.1%, who had received the new class of diabetes and weight-loss drugs.

By Katelyn Jetelina
Your Local Epidemiologist

You’ve probably heard of Ozempic by now. It is everywhere. Sales are up more than 300% and research studies are coming out like a firehose, but future population-level implications are unknown. Here, we catch you up on the science and what it may mean for you.

Ozempic (one brand name for the substance semaglutide) is one of many medications under the umbrella of “GLP-1 receptor agonists.” Others are Trulicity (dulaglutide), Wegovy (semaglutide) and Mounjaro (tirzepatide).

GLP stands for glucagon-like peptide 1. GLP-1 is a hormone produced in the intestinal system and released when you eat food. It is a natural signal saying you have eaten enough food. Naturally occurring GLP-1 comes and goes in a few minutes.

These medications mimic this natural process but for longer. Ozempic, for example, stays in our system for an entire week. It also slows down gastric emptying, thereby slowing down digestion.

How effective are these drugs? Very. The original clinical trials that supported initial FDA approval for patients with diabetes blew expectations out of the water. It improved:

• Blood sugar control (A1c reduction)
• Weight loss (average 15 pounds)
• Unexpected positives, like reduced kidney disease (24% less likely to experience kidney failure and death due to kidney complications)

Since the first clinical trials, studies have tested its use in non-diabetic individuals, and its is effective in weight loss. A meta-analysis of eight studies found a significant decrease (about 10% of body weight). None saw an increase. Also, it has protective effects on the heart, such as reduced blood pressure and triglycerides.

 
What happens if you stop taking it? Unfortunately, weight (and other outcomes) rebound. As shown below, after the original clinical trial (68 weeks), people who stopped taking it regained their weight.

The use of GLP-1’s as a motivating tool for sustained change has been less studied. Will these be lifetime drugs like other medications (e.g., statin drugs for heart disease) or a tool to titer up or down in times of need? This is a big unanswered question.

While obesity often involves an energy imbalance where calories consumed exceed those expended, it’s influenced by genetics, socioeconomic status, environmental factors, and mental health. These factors contribute to a complex web of challenges that may extend beyond individual choices alone.

What about kids? Ozempic isn’t officially approved by the FDA for children (but can be used off-label), but Wegovy is approved. In 2023 alone, about 31,000 children aged 12 to 17 and 162,000 aged 18 to 25 used these medications.

A recent meta-analysis found treatments led to modest reductions in body weight and improved glycemic control in children with insulin resistance.

Ozempic babies? The term refers to a recent phenomenon where women are reporting unplanned pregnancies. This has sparked discussions on social media and in the medical community about the potential impact of these drugs on fertility. Why could this be happening? Two hypothesized pathways:

• 1. These drugs delay gastric emptying, which can impact the effectiveness of oral birth control by slowing down the rate of absorption
• 2. Weight loss enhances fertility, making it easier for women to become pregnant. This is particularly true for women with Polycystic Ovarian Syndrome, in which weight loss is known to boost fertility significantly.

However, it’s recommended to stop the medication two months before trying to get pregnant (see more below).

 

Datawrapper graph by YLE; data from Ghusn et al., JAMA

Are there downsides to the meds?

Like any medication, there are side effects and risks, some known and some theoretical, and many with mixed study results. Individuals must weigh the risks of obesity with the small but meaningful risks of the medication.

 
Many people experience side effects, particularly nausea and diarrhea. A recent analysis from an insurance agency found that 6 in 10 people who start the drugs quit before they see benefits because of side effects. These tend to go away after a few weeks, but they can substantially impact the quality of life until then.

Muscle loss: Most (60-75%) weight loss is from fat, but some is from non-fat, including muscle. This could lead to a rare condition called sarcopenia—loss of muscle mass and strength where you can’t do much because you’re physically weak. Research is mixed, though, on how often this happens, and it may be minimal when combined with exercise and adequate protein intake.

 
Increased risk of thyroid cancer. A small French case-control study found an elevated risk of thyroid cancers (58% elevated relative risk) and medullary thyroid cancer (78% elevated relative risk) after GLP-1’s. However, another study in Scandinavia with more than 400,000 people found no risk of thyroid cancer after 3 years. Regardless, the potential increase in absolute risk is very small.

Mental health. There is a big debate on what is happening in the brain. GLP-1 is not only produced in the gut but in the brain as well. Some evidence has correlated the usage of GLP-1 medications with suicidal ideation. However, recent evaluations by regulatory agencies found no substantial evidence after extensive review. Some studies have even suggested a potential decrease in the likelihood of anxiety and depression.

Eating disorders. It is a growing concern that GLP-1s may increase the risk of disordered eating, particularly among those who are high-risk (e.g., prior history of eating disorders).

 
Pregnancy. Pre-clinical trials on rats found GLP-1s are more likely to have offspring with birth deformities, so it’s not recommended to take during pregnancy.

While these new drugs have a strong safety profile based on available data, human studies are only about 5 years old. This means the long-term effects are not yet fully understood. However, we do have data from drugs in the same class that started testing in 2006, showing a consistent safety profile. Continued monitoring and research are essential to determine whether theoretical risks are real in light of new data.

This means decisions today must be made based on what is available and in the context of individual risk factors. For example, if you have a history of eating disorders, the risks of taking the medication may outweigh the benefits.

What does the future look like? After a century of fad diets and weight loss gimmicks, people are tired: some from fighting stigma and others from trying to lose weight unsuccessfully. These medications have proven to work, and the market shows it: GLP-1 prescriptions have increased by over 300% since 2020. A recent poll indicates that nearly half of adults express interest. But there’s no sugarcoating it: It’s expensive, about $1,000 per month without insurance. The price should decrease dramatically in about 8 years once the patent expires and the generic version comes to market.

On a population level, these drugs will likely have widespread impacts, just like the iPhone, which can be good or bad, depending on who you ask. Given the massive impact obesity has had on health in the past two decades, this could be extraordinary for lifespan and quality of life. It could also have ripple effects on the fast-food industry and save millions of dollars in health care costs.

But it could further widen health disparities, given the cost, and hurt body positivity, losing much ground gained. We also cannot ignore that these drugs benefit a billion-dollar pharmaceutical industry when underlying societal causes should be addressed for prevention. And, the fact there are numerous other benefits to a healthy lifestyle.
Bottom line

GLP-1 drugs offer much-needed hope to individuals, and a flood of studies show their effectiveness. However, there are both demonstrated and theoretical risks to consider. Regardless, obesity deserves compassion, and perhaps 21st-century tools can help foster a supportive environment that promotes lasting progress.

Surgeon general wants health warnings on social-media platforms, which he blames for mental illnesses among youth

Surgeon General Vivek Murthy (AP photo by Susan Walsh)

By Michelle Chapman
Associated Press

The U.S. surgeon general has called on Congress to require warning labels on social media platforms and their effects on young people’s lives, similar to those now mandatory on cigarette boxes.

In a Monday opinion piece in the The New York Times, Dr. Vivek Murthy said that social media is a contributing factor in the mental-health crisis among young people.

“It is time to require a surgeon general’s warning label on social-media platforms, stating that social media is associated with significant mental health harms for adolescents. A surgeon general’s warning label, which requires congressional action, would regularly remind parents and adolescents that social media has not been proved safe,” Murthy said. “Evidence from tobacco studies show that warning labels can increase awareness and change behavior.”

Murthy said that the use of just a warning label wouldn’t make social media safe for young people, but would be a part of the steps needed.

Social media use is prevalent among young people, with up to 95% of youth ages 13 to 17 saying that they use a social media platform, and more than a third saying that they use social media “almost constantly,” according to 2022 data from the Pew Research Center.

“Social media today is like tobacco decades ago: It’s a product whose business model depends on addicting kids. And as with cigarettes, a surgeon general’s warning label is a critical step toward mitigating the threat to children,” Josh Golin, executive director at Fairplay, an organization that is dedicated to ending marketing to children, said in a statement.

Actually getting the labels on social media platforms would take congressional action — and it’s not clear how quickly that might happen, even with apparent bipartisan unity around child safety online. Lawmakers have held multiple congressional hearings on child online safety and there’s legislation in the works. Still, the last federal law aimed at protecting children online was enacted in 1998, six years before Facebook’s founding.

“I am hoping that would be combined with a lot of other work that Congress has been trying to do to improve the safety and design and privacy of social media products,” said Dr. Jenny Radesky, a developmental behavioral pediatrician at the University of Michigan and leader at the American Academy of Pediatrics. “Those two things would have to go hand in hand, because there’s so much that Congress can do to follow the steps of the United Kingdom and the European Union in passing laws that take into account what kids need when they’re interacting with digital products.”

Even with Congressional approval, warning labels would likely be challenged in the courts by tech companies.

“Putting a warning label on online speech isn’t just scientifically unsound, it’s at odds with the constitutional right to free speech,” said Adam Kovacevich, CEO of the tech-industry policy group Chamber of Progress. “It’s surprising to see the U.S. surgeon general attacking social media when teens themselves say it provides an important outlet for social connection.”

Last year, Murthy warned that there wasn’t enough evidence to show that social media is safe for children and teens. He said at the time that policymakers needed to address the harms of social media the same way they regulate things like car seats, baby formula, medication and other products children use.

To comply with federal regulation, social media companies already ban kids under 13 from signing up for their platforms — but children have been shown to easily get around the bans, both with and without their parents’ consent.

Other measures social platforms have taken to address concerns about children’s mental health can also be easily circumvented. For instance, TikTok introduced a default 60-minute time limit for users under 18. But once the limit is reached, minors can simply enter a passcode to keep watching.

Murthy believes the impact of social media on young people should be a more pressing concern.

“Why is it that we have failed to respond to the harms of social media when they are no less urgent or widespread than those posed by unsafe cars, planes or food? These harms are not a failure of willpower and parenting; they are the consequence of unleashing powerful technology without adequate safety measures, transparency or accountability,” he wrote.

In January the CEOs of Meta, TikTok, X and other social media companies went before the Senate Judiciary Committee to testify as parents worry that they’re not doing enough to protect young people. The executives touted existing safety tools on their platforms and the work they’ve done with nonprofits and law enforcement to protect minors.

Murthy said Monday that Congress needs to implement legislation that will protect young people from online harassment, abuse and exploitation and from exposure to extreme violence and sexual content.

“The measures should prevent platforms from collecting sensitive data from children and should restrict the use of features like push notifications, autoplay and infinite scroll, which prey on developing brains and contribute to excessive use,” Murthy wrote.

Sens. Marsha Blackburn (R-Tenn.) and Richard Blumenthal (D-Conn.) supported Murthy’s message Monday.

“We are pleased that the surgeon general — America’s top doctor — continues to bring attention to the harmful impact that social media has on our children,” the senators said in a prepared statement.

The surgeon general is also recommending that companies be required to share all their data on health effects with independent scientists and the public, which they currently don’t do, and allow independent safety audits.

Murthy said schools and parents also need to participate in providing phone-free times and that doctors, nurses and other clinicians should help guide families toward safer practices.

While Murthy pushes for more to be done about social media in the United States, the European Union enacted groundbreaking new digital rules last year. The Digital Services Act is part of a suite of tech-focused regulations crafted by the 27-nation bloc — long a global leader in cracking down on tech giants.

The DSA is designed to keep users safe online and make it much harder to spread content that’s either illegal, like hate speech or child sexual abuse, or violates a platform’s terms of service. It also looks to protect citizens’ fundamental rights such as privacy and free speech.

Officials have warned tech companies that violations could bring fines worth up to 6% of their global revenue — which could amount to billions — or even a ban from the EU.

Murthy’s focus is on teens and social media, but Radesky noted that adults could use a warning label too.

“What we’ve heard from teens is that they want their parents to be on social media less and on their devices less,” she said. “That’s another behavior change we hope that parents will reflect on and think about — ‘where could I cut down or create some boundaries to create more family time or sleep time?’ — and not only hyper-focusing on what teens are doing, but really what all of us as a society are doing in terms of healthy relationships with technology.”

UPDATE, June 19: "Some scientists who study youth mental health say the evidence does not support the notion that social media is harmful per se," The New York Times reports.

Learning CPR for children and infants could help save a little life

(Photo from Prostock-Studio, via iStock/Getty Images Plus)

By Dr. Callie L. Rzasa

University of Kentucky

More than 23,000 children in the United States suffer an out-of-hospital cardiac arrest annually. Although the reported number of infant out-of-hospital cardiac arrests varies widely, only 6.5% for children less than 1 year old who experience an out-of-hospital cardiac arrest survive to hospital discharge.

According to the National Center for Injury Prevention and Control, unintentional choking and suffocation are a leading cause of all injury deaths for infants less than a year old. Nearly 3,500 infants die each year in the U.S. from sleep-related infant deaths such as suffocation, entrapment, strangulation and sudden infant death syndrome.

Make safety a habit at home by implementing safe sleep practices, such as making sure babies sleep in their own crib or bassinet on a firm, flat surface without potential suffocation hazards such as blankets, stuffed animals or crib bumpers.

New parents, grandparents, babysitters and caregivers should take the time to learn infant- and child-specific CPR (cardiopulmonary resuscitation). It’s important to remember if the child is unresponsive, not breathing or only gasping, call 911 and start CPR immediately.

For a child 1 or older:

• Push on the middle of the chest 30 times at a depth of 2 inches with one or two hands at a rate of 100 to 120 compressions per minute.
• Provide 30 compressions and then give two rescue breaths.
• Repeat cycles.

For an infant younger than 1:

• Push on the middle of the chest 30 times at a depth of 1½ inches with two fingers at a rate of 100 to 120 compressions per minute.
• Provide 30 compressions and then give two rescue breaths.
• Repeat cycles.

If you have access to an automated external defibrillator, use it as soon as possible. Most AEDs are equipped with child- and infant-sized pads. They can help guide CPR and provide treatment for certain heart arrhythmias. Continue compressions until emergency services arrives.

For more information about CPR for adults, children and infants, find a class or training center near you.

Callie L. Rzasa, M.D., is medical director of Kentucky Children's Hospital Congenital Heart Clinic and American Heart Association board president in Central and Eastern Kentucky.

Men's Health Month a reminder to schedule preventive screenings

By Melissa Patrick
Kentucky Health News

Men's Health Month in June is a reminder for men to think about their health and consider making some screening appointments that could lengthen, or even save, their lives. 

Why is it so important for men to take care of themselves? For one thing, on average in the United States, men die nearly six years earlier than women. 

That is a wider gap than before the pandemic, which took a disproportionate toll on men. Researchers also note that men are more prone to unintentional injuries, such as drug overdoses and  accidents. Homicides, heart disease and suicides also contribute to the worsening life expectancy for men. 

Men's Health Month is a time for men to take charge of their health and to schedule their preventive  health screenings, especially for the conditions that if caught and treated early could save their life. 

Some recommended screenings include: 

 

Heart disease is the leading cause of death in men, according to the Centers for Disease Control and Prevention.  The American Heart Association says the key screenings for heart health involve an annual physical that include test for blood pressure, cholesterol, body weight and diabetes. Smoking is also a major cause of heart disease, and a health-care provider can help with a cessation plan. 

Skin cancer: Increased sun exposure and fewer trips to the doctor put men at a higher risk of developing skin cancer, so it's important to not only protect your skin when outdoors, but to see a dermatologist if you notice any change in a mole's color or appearance, or if they bleed, ooze, itch, appear scaly or become tender or painful. A dermatologist can also do a full-body skin cancer screening. 

Lung cancer: Kentucky still has one of the highest smoking rates in the nation and leads the nation in lung-cancer cases and deaths. Lung-cancer screening via low-dose computed tomography (a low-dose CT scan) is recommended for anyone 50 to 80 who smokes or has quit in the past 15 years and has at least a 20 pack-year smoking history (a pack per day for 20 years or two packs per day for 10 years). 

Prostate cancer: On average, one in eight men will be diagnosed with prostate cancer and it is the second leading cause of death among men, according to the American Cancer Society. It is recommended that prostate cancer screenings for men who are at average risk begin at age 50. 

Colon cancer: Routine screening for colorectal cancer is recommended to start at age 45. Men with a family history of the cancer may be advised to get screened earlier.

Diabetes: In Kentucky, about 100,000 people have diabetes and don't know it. That's why it's important to get screened with a blood test even when you don't think you have any symptoms.

Mental health: A primary-care provider is a good place to start if you are seeking help with a mental-health concern. Mental Health America of Kentucky also offers a free, online mental-health screening. The new, national 988 suicide/crisis hotline is available 24/7.

"While men are diagnosed with depression half as often as women and are less likely to attempt suicide, men die by suicide three to four times more frequently," says a peer-reviewed article in the American Medical Association Journal of Ethics by Nathan Swetlitz. "Although there is no one-to-one correspondence between depression and suicide, depression is one of suicide’s most significant risk factors."

Independent pharmacists start ads asking Congress for relief from pharmacy benefit managers, ask Supreme Court to hear a case

Photo by Getty Images via The Commonwealth Fund

Kentucky Health News

Independent community pharmacists have begun an advertising campaign to get Congress to rein in pharmacy benefit managers, the middlemen between drug and health-insurance companies. They are also challenging a court ruling that could negate the PBM reforms made by Kentucky and other states.

The ad campaign was launched Thursday, June 13, by the National Community Pharmacists Association. Its CEO, B. Douglas Hoey, said "Eighty percent of all prescriptions in the U.S. are controlled by just three pharmacy benefit managers, and they are all owned by or affiliated with the largest insurance companies in the country. These are Fortune 15 corporations that behave like monopolies, and they are hurting patients with higher prescription costs and killing off small businesses at the average rate of one every day. There is broad bipartisan support in Congress for reform, and we are determined to get it passed before the end of the year."

On Friday, June 14, NCPA joined other pharmacy groups in asking the U.S. Supreme Court to reverse a recent decision from the Tenth Circuit Court of Appeals against a 2019 Oklahoma law than bans PBMs from requiring patients to pick up their prescriptions from PBM-affiliated pharmacies. The groups say the ruling "imperils laws enacted in almost every other state following the 2020 Supreme Court ruling" that approved state regulation of PBMs, reports Gabrielle Wanneh of Inside Health Policy.

In 2023, the Kentucky General Assembly passed Senate Bill 188, aimed at keeping the state's independent pharmacies from closing. It sets dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own. The PBMs argued that the law will cause insurance premiums to increase and its mandates in the bill won't allow businesses to gain from savings that PBMs offer.

Independent pharmacies say they are losing money because of low fees paid by PBMs. The bill sets a minimum dispensing fee of $10.64 per prescription for the state's independent pharmacies until a study of dispensing costs is completed by the state Department of Insurance. This "gap-fill payment floor" will not be available to chain pharmacies. The results of the study will eventually dictate what the dispensing fee should be going forward. The study is to be repeated every two years, with fee adjustments made accordingly.

The law, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And a PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

In third round of grants from opioid settlements, director passes on one, saying Coleman opposes syringe-exchange programs

Russell Coleman announced Chris Evans's
appointment on Dec. 19. (WKYT image)

By Melissa Patrick
Kentucky Health News
 

The leader of the agency that makes grants from the state's opioid settlements declined to vote for a grant with more money for a syringe-exchange program, saying Attorney General Russell Coleman does not support such programs -- which are considered a key tool for reducing harm to people who inject drugs.

Kentucky Opioid Abatement Advisory Commission Director Chris Evans, who works for Coleman, passed on a June 4 vote that approved a grant to the Boyle County Agency for Substance Abuse Prevention, one of 119 such county agencies.

"This application does increase outreach, which includes educational training, Narcan distribution and referrals to treatment," Evans said. "However, the request does increase the funding of the syringe-service position, which the Office of the Attorney General does not support syringe exchange programs. So I will be passing on the vote of this application."

Asked later why Coleman opposes syringe-exchange programs, Coleman spokesman Kevin Grout said in an email, "Attorney General Coleman is committed to supporting effective prevention, treatment and enforcement efforts. He strongly supports the distribution of Naloxone and other overdose reversal drugs. However, he cannot support syringe-exchange programs, which he believes enable drug use without effectively promoting recovery."

Syringe exchanges are supported by research. The Centers for Disease Control and Prevention says injection drug users who have access to syringe exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

The exchanges were authorized by the state's 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. As of March 14, the state had 80 operational syringe exchange programs in 65 counties.

Later voting against the grant request because of their opposition to syringe exchange programs were commission members State Treasurer Mark Metcalf and retired Master State Trooper Darren "Foot" Allen, whom Coleman appointed to fill a slot representing law enforcement.

Allen said, "There's some people that I trust that tell me this is okay. However, I'm just not in favor of needle exchange. I suspect that this time next year, I won't change my position but I am open to looking at that option," he said. 

Despite the opposition, Boyle County's ASAP grant request for $282,610 passed with a 6-2 majority vote. The commission is comprised of nine voting and two non-voting members from the legislature.

Third round of grants approved

The Boyle County grant was the only one put up for a vote that had any opposition at the commission's June 4 meeting. In all, the commission members approved 51 organizations to receive just over $12 million in grant money. 

The legislature created the commission to distribute the state's portion of the approximately $900 million in settlements with opioid manufacturers and distributors, half of which goes to the state and the other half goes to cities and counties. The commission is housed in the attorney general's office and is headed by Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Of the $12 million in this round of grant money, 28 of the awards were given for treatment and recovery, and 23 were given for prevention. This is the third round of state grants, with $32 million awarded to 59 groups in the first round and $13.9 million awarded to 34 groups in the second round.

Asked for brief details of each grant, Grout said they would be announced next Thursday at a press conference at DV8 Kitchen-East End in Lexington, one of the grant recipients.

The 28 new treatment and recovery grants are:

Appalachian Regional Healthcare, $94,572.
Backroads of Appalachia, $167,025.
Boyle County ASAP Board, $282,610.
Celebrate Recovery Fairdale, $30,004.
Center for Employment Opportunities, $255,109.
Chrysalis House, $227,273.
Comprehend Inc., $426,087.
Eastern Kentucky Concentrated Employment Program, $450,000.
Family Nurturing Center of Kentucky, $221,937.
Family Scholar House, $245,110.
Grin Grant, Lexington, $361,251.
Hope Center, Lexington, $680,280.
Hope Springs Church, $50,462.
Horsesensing Inc., $115,219.
Isaiah House, $250,000.
Ky. Hospital Research and Ed. Foundation (Ky. Hospital Assn.), $250,000.
Lake Cumberland Area Development District, $277,552.
Life Learning Center, $498,500.
Mercy Health - Marcum and Wallace Hospital, Irvine, $179,834.
Natalie's Sisters, $88,356.
Northeast Kentucky Regional Health Information Organization, $331,997.
Ramey-Estep Homes, $222,801.
Recovery Café Lexington, $276,278.
Transitions Inc., $156,000.
Voices of Hope - Lexington, Inc., $538,021.
Volunteers of America Mid-States, $664,587.
Four Rivers Behavioral Health, $232,251.
Young People in Recovery, $301,440.

The 23 new prevention grants are:

Anderson County ASAP, $171,100.
Appalachian Research & Defense Fund (Legal Aid), $125,000.
Big Brothers Big Sisters of the Bluegrass, Inc., $185,301.
Boys and Girls Clubs of Kentuckiana, $200,000.
Carter County Public Library, $101,500.
Covington Partners, $225,450.
Cumberland Trace Legal Services (Legal Aid), $125,000.
DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730.
Girl Scouts of Kentucky Wilderness Road Council, $59,052.
Jewish Family and Career Services, $77,207.
Legal Aid Society, $125,000.
Legal Aid of the Bluegrass, $125,000.
Mercy Health - Lourdes Hospital, $76,552.
Operation Parent, $87,011.
The Safety Blitz Foundation, $126,335.
Scott County Sheriff's Office, $91,847.
Taylor County Schools, $208,824.
Three Rivers District Health Department, Owenton, $320,803.
University of Kentucky Research Foundation, $380,572.
Operation UNITE, $751,850.
Wanda Joyce Robinson Foundation, $90,472.
WestCare Kentucky, $100,404.
Young Men’s Christian Association of Greater Louisville, $248,487.

The grant application portal is closed until the commission opens it for the next round of awards.