4 community mental health centers in 35 counties to consolidate

Graphic from mental-health agencies' press release

Four nonprofit mental-health agencies in Kentucky are creating a new partnership that they say will help them improve clinical programs and alliances and protect the safety-net services in rural communities.

LifeSkills Inc. of Bowling Green, Communicare Inc. of Elizabethtown, Four Rivers Behavioral Health of Paducah and Pennyroyal Center of Hopkinsville would form one of the largest community health centers in the state.

The agencies say they have signed a letter of intent, are near the end of the due-diligence process, and expect to complete the consolidation by July 1. A name for the new organization will be announced later.

Joe Dan Beavers

Joe Dan Beavers, president and CEO of LifeSkills, will serve as the initial CEO but existing leaders from all four agencies will play a role in the partnership.

The organizations say they support more than 47,000 individuals annually and employ 1,700 people across 35 counties.

The new organization will offer more than 70 programs and services in 129 locations and employ more than 220 licensed behavioral-health clinicians. It will also serve children and adults in more than 225 schools and have budget of more than $180 million.

Covid-19 hospitalizations are on the decline in Kentucky, even as weekly case numbers bounce up and down; rate still first in nation

Screenshot of New York Times interactive map shows why Kentucky's new-case rate tops the U.S.

By Melissa Patrick
Kentucky Health News

While Kentucky's new coronavirus case numbers continue to fluctuate from week to week, the number of people hospitalized with the virus is declining. 

The state Department for Public Health's latest weekly report showed 5,665 new cases of the virus last week, or 809 cases per day. That's down 11% from the week before when the state reported 6,369 new cases. People 18 and younger make up 18% of the new cases, the state said. 

The share of Kentuckians testing positive for the coronavirus in the past seven days was 9.93%, down slightly from 10.05% the week prior. These numbers do not reflect at-home testing. 

The weekly new-case rate was 13.04 cases per 100,000 residents, up slightly from 12.98 cases the week before. The top 10 counties were Breathitt, 46.4 cases per 100,000; Monroe, 33.5; Powell, 33.5; Whitley, 28.8; Metcalfe, 28.4; Greenup, 27.3; Harlan, 25.8; Estill, 25.3; Boyd, 24.8; and Clark, 23.2.

The New York Times ranks Kentucky's new-case rate first in the nation, even though it has seen a 27% drop in cases in the last two weeks. Rhode Island ranks closely behind Kentucky. 

Like the rest of the nation, Kentucky's Covid-19 hospitalization numbers are declining. Kentucky hospitals reported 286 patients with Covid-19, down eight from last week; 46 patients in intensive care, down 10; and 23 on mechanical ventilation, down one. 

The state attributed 49 more deaths to Covid-19 last week, down from 52 the week before. Kentucky's pandemic death toll is now 17,939. 

Cameron is among 20 Republican attorneys general warning CVS and Walgreens that mail-order abortion pills are unlawful

By Melissa Patrick

Kentucky Health News

Attorney General Daniel Cameron joined a coalition of 20 Republican attorneys general in sending a letter to Walgreens and CVS saying their plans to distribute abortion pills through the mail are unlawful. 

Daniel Cameron

“Having failed to halt the overturning of Roe v. Wade, the Biden Administration is now promoting its abortion priorities by misinterpreting federal laws that clearly prohibit distributing abortion drugs by mail,” Cameron said in a news release. 

The coalition says federal law prohibits anyone from using the mail to send or receive any drug that will "be used or applied for producing abortion," referring to the Comstock Act of 1873.

Last month, the U.S. Department of Justice issued a legal opinion finding that mailing abortion drugs does not violate the Comstock Act and said the Postal Service is legally allowed to deliver prescription abortion pills to people in states that have strict bans on abortions, like Kentucky currently does. 

The opinion said the Comstock Act “does not prohibit the mailing of certain drugs that can be used to perform abortions where the sender lacks the intent that the recipient of the drugs will use them unlawfully.” It added, “Because there are manifold ways in which recipients in every state may lawfully use such drugs, including to produce an abortion, the mere mailing of such drugs to a particular jurisdiction is an insufficient basis for concluding that the sender intends them to be used unlawfully.”

After the legal opinion was issued, CVS and Walgreens announced plans to sell abortion pills through the mail.

In their letter, the attorneys general informed CVS and Walgreens that the Biden Administration has misinterpreted federal law. 

The coalition writes, “Although many people are unfamiliar with this statute because it has not been amended in a few decades, the text could not be clearer: “Every article or thing designed, adapted, or intended for producing abortion … shall not be conveyed in the mails.’”

Further, the attorneys general also warned that sending abortion pills through the mail may violate the laws of many states across the country.

"In Kentucky, the Human Life Protection Act prohibits “procur[ing] for” or “sell[ing] to any pregnant woman any medicine, drug, or other substance with the specific intent” of causing an abortion," says the release. 

The coalition also says “abortion pills are far riskier than surgical abortions,” and according to medical consensus are “5.96 times as likely to result in a complication as first-trimester aspiration abortions.” 

The Guttmacher Institute, a reproductive-health research and policy organization, disagrees, saying on its website: " A safe and effective option at early gestations, medication abortion accounted for more than one-third (39%) of all abortions in the United States in 2017. Medication abortion is as safe as surgical abortion, but is noninvasive and can be completed in a patient’s chosen setting, such as at home." 

The Kaiser Family Foundation says, "The FDA has found that medication abortion is a safe and highly effective method of pregnancy termination. When taken, medication abortion successfully terminates the pregnancy 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%)."

Cameron, who is seeking the Republican nomination for governor, signed the letter with attorneys general from Alabama, Alaska, Arkansas, Florida, Georgia, Indiana, Iowa, Louisiana, Mississippi, Missouri, Montana, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, and West Virginia.

To read the letter to CVS, click here; to see the letter to Walgreens, click here.

Delta-8 THC, mildly less potent than marijuana's delta-9, is legal in Ky. but has risks and new rules; could face further regulation

Delta-8 gummies on sale in Louisville (Courier Journal photo by Jeff Faughender)

Kentucky Health News

"While politicians debate whether to legalize medical marijuana in Kentucky, a lesser-known product that gets people similarly high is flourishing in the state. And it's already legal," reports Morgan Watkins of the Courier Journal.

Delta-8 tetrahydrocannabinol, which is moderately less potent but "almost identical to the delta-9 THC in marijuana that drives the mental high" can be sold to anyone in Kentucky, "theoretically even children, at the seller's discretion," Watkins reports.

That's due to a law passed by Congress, and the unwritten law of unintended consequences.

"The delta-8 business bloomed from an unforeseen loophole thanks to a law federally legalizing hemp, a cannabis plant with very little delta-9 THC," which U.S. Sen. Mitch McConnell got passed to help farmers raise hemp, Watkins writes. "Delta-8 can be indirectly derived from hemp, and the way the 2018 law was written opened the door for businesses to make and sell it."

The door opened wider last year, after a circuit judge in Boone County "ruled delta-8 is allowed as long as such products don't have a higher concentration of delta-9 than federal law permits," Watkins notes. "Dozens of business owners in the Louisville area gradually have put delta-8 vapes and edibles on their shelves. This upstart market even fueled the opening of new stores."

Into that regulatory gap has jumped Democratic Gov. Andy Beshear. When he issued an executive order for medical marijuana last fall, he issued another requring delta-8 products to "meet certain rules, including packaging and labeling requirements that apply to other hemp-derived materials," Watkins notes.

New legal challenges could arise at the Kentucky General Assembly, which is again debating the issue of medical marijuana. The state Senate banned delta-8 last year, "but the bill died in the House," Watkins notes. "Conversely, the House has passed legislation to permit medical marijuana in recent years that died in the Senate."

Some in the industry told Watkins that delta-8's popularity in states such as Kentucky, Indiana and Tennessee stems from the fact that medical and recreational marijuana aren't legal there. Jim Higdon, co-founder of Kentucky-based cannabidiol brand Cornbread Hemp, told her: "As a product of prohibition, delta-8 THC is the bathtub gin of our generation."

Delta-8 can be produced from cannabidiol, or CBD, Watkins notes: "The resulting oil is then used in products. With minimal-to-no regulations in various states, pretty much anyone can make delta-8."

But the product has risks. Kent Vrana, pharmacology chair at Penn State, told Watkins that delta-8 products may contain heavy metals, chemical solvents and pesticides. "Using delta-8 also involves some of the same risks as using marijuana, Vrana said, including the possibility of developing an addiction. The U.S. Food and Drug Administration hasn't evaluated or authorized delta-8 products "for safe use in any context." Vrana said research into medical marijuana shows it can stimulate the appetite and limit seizures, and there are indications it can help manage pain. He said there’s no question delta-8 has similar potential."

Alzheimer's drug under study at University of Ky. and other sites has shown it is 'the first crack in the iceberg,' UK researcher says

By Al Cross
Kentucky Health News

A partially approved drug for Alzheimer's disease that slowed memory decline and loss of functional ability in a study is “the first crack in the iceberg for us,” says a Kentucky researcher involved in the study.

Dr. Greg Jicha of the University of Kentucky, one of about 100 study sites, told reporters last week that he expects more progress.  “Hopefully the day will come when Alzheimer’s will be no more,” he said. “This is fundamentally the start of that process.”

Dr. Greg Jicha (UK photo by Mark Cornelison)

Jicha said in a UK news release, “For the first time, having a medication that we understand can fundamentally change the disease process is the first step and it’s a giant step,” said Jicha. “It tells us and teaches us all that we are on the path to the eventual cure for Alzheimer’s that we’re all looking for.”

On Jan. 6, the Food and Drug Administration approved the drug lecanemab for Alzheimer's patients who have mild cognitive impairment or are in the mild dementia stage of the disease.

That's the population being studied in clinical trials, which have found that the drug slowed memory decline by 27 percent and the loss of functional ability by 40%. While the drug does not cure the disease, it "could mean two to two and a half more years of functional life," Jicha told reporters. "That is meaningful; an extension of quality of life."

Jicha said several medicines are available for Alzheimer's, but they treat only symptoms of the disease, and the last one was approved 20 years ago.

The drug removes from the brain the amyloid proteins that are believed to cause Alzheimer's. The plaques can show up in people with very mild memory problems, Jicha said; one of three Americans over age 65 have them.

The study continues, to see if the drug can be used to remove plaques earlier and delay onset of teh disease, Jicha said. "Hopefully we’ll have that answer in the next five to seven years."

UK is still recriting participants for the study. It uses a simple blood test for the protein or likelihood of buildup. If there is a high likelihood, imaging of the brain can see the plaques may be performed. If they are found, the person gets into the study. But only half of them get the drug; the others get a placebo, which is standard for clinical trials. They could get the drug if the study is successful, Jicha said.

To learn more about the study, call 1-800-AHEAD-70 or to find a trial site location enrolling near you, visit www.AHEADstudy.org.

The next step in the study could lead to approval for payments by Medicare and private insurance. The drug's manufacturer, the Japanese firm Esai, says it would like to charge $26,000 a year for the treatment, which requires an infusion every two weeks. Jicha said the Institute for Clinical and Economic Review, a nonprofit organization that does clinical and cost-effectiveness analyses of treatments, has suggested an annual price of $21,000.

Fewer Kentuckians enrolled in federally subsidized health plans for 2023, likely because many of them could remain on Medicaid

By Melissa Patrick

Kentucky Health News

Fewer Kentuckians signed up for a government-subsidized health plan on Kynect, the state-based marketplace, in 2023 than in the previous two years, likely because more of them qualified for Medicaid during the pandemic and were still covered by it. 

The final Centers for Medicare & Medicaid Services 2023 open enrollment report shows 62,562 Kentuckians signed up for health insurance on Kynect through Jan. 15, which was the last day to enroll.  That's a 15% drop from 73,935 in 2022 and a 19% drop from 77,821 in 2021, according to last year's report. 

"Our best guess is that more Kentuckians are currently covered by Medicaid right now because of the continuous-eligibility provision that's been in place during the pandemic," Emily Beauregard, executive director at Kentucky Voices for Health, said in an email. "When renewals begin this spring, we expect some Kentuckians enrolled in Medicaid to move" to a private but federally subsidized Qualified Health Plan. 

Beauregard referred to the end of a federal program that kept people continuously enrolled on Medicaid during the pandemic without the need to re-enroll and certify their incomes to qualify. This program will end March 31, under an end-of-year omnibus law that requires Medicaid agencies to restart their annual renewal process. This process has been dubbed "Medicaid unwinding." 

At a Jan. 12 state Senate and House Joint Health Services Committee meeting, Veronica Judy-Cecil, senior deputy commissioner of the state Department for Medicaid Services, gave a snapshot of how many Kentuckians this will affect.

She said the state estimates that of the 1.7 million Kentuckians on Medicaid, 243,368, about 14%, will lose eligibility during the unwinding. Slides presented at Beshear's Feb. 2 news conference indicated that the estimated number of people impacted by the unwinding has gone up to 260,000.

Of that group, an estimated 85,400 have incomes over 138% of the federal poverty level, the Medicaid limit, and will qualify for a qualified health plan with federal tax credits through Kynect. 

Private insurance plans purchased on Kynect offer significant tax subsidies to offset insurance costs for people earning between 100% and 400% of the federal poverty level, or between $13,590 and $54,360 for an individual. About 80% of enrollees nationwide qualify for subsidies that reduce their monthly payments to less than $10, according to the federal Department of Health and Human Services.

Beshear says 'it's time' to end U.S. Covid emergency, set May 11, but notes expiring programs; estimated 260,000 to lose Medicaid

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear agreed with President Biden's decision to end the Covid-19 public health emergency on May 11, a decision that will bring an end to several programs that were put in place to help people during the worst of the pandemic.  

"I think it's time," Beshear said at his weekly news conference Thursday. "We are in a much different and a much better place with the pandemic. People have the information they need, and everyone has the ability to protect themselves to the best of their ability through a series of steps." 

The governor didn't specify them, but those steps include getting a Covid-19 vaccination and booster, wearing a high-quality mask in public indoor spaces or avoiding non-essential indoor activities if you are at high risk of getting sick, getting tested before having social contact with others who are at high risk of severe disease, and to wear a mask if you are with them. And, to stay home if you are sick. 

Beshear said he didn't support Kentucky legislators' decision to end the commonwealth's Covid-19 state of emergency in March 2022 because it caused Kentuckians to lose money for federal food assistance. 

Beshear noted several programs that will end when the national state of emergency ends, including free Covid-19 testing and treatment and the Rental Assistance Program, which he said is already running out of money. 

In a detailed explainer about what the end of the Covid-19 public health emergency will mean to health coverage and access, the Kaiser Family Foundation says Covid-19 vaccinations, testing and treatment will continue to be free to all people as long as the supply of federally purchased vaccines last. 

But when the federally purchased supplies run out, KFF says there will likely be a co-payment for all testing and treatment for people with insurance. Vaccines must remain free to most people with private and public insurance under the 2010 Patient Protection and Affordable Care Act, but that rule does not apply to the uninsured or underinsured. 

Medicaid unwinding

One pandemic benefit that is ending made it easier for low-income people to sign up for free health care through Medicaid and kept states from kicking them off the program. That will change, as part of an end-of-year omnibus law that requires Medicaid agencies to restart their annual renewal process.  This process has been dubbed "Medicaid unwinding." 

At a Jan. 12 state Senate and House Joint Health Services Committee meeting, Veronica Judy-Cecil, senior deputy commissioner of the state Department for Medicaid Services, gave a snapshot of how many Kentuckians this will affect. 

She said the state estimates that of the 1.7 million Kentuckians on Medicaid, 243,368, about 14%, will lose eligibility during the unwinding. Slides presented at Beshear's Feb. 2 news conference indicated that the estimated number of people impacted by the unwinding has gone up to 260,000.

 

Of that group, an estimated 85,400 have incomes over 138% of the federal poverty level, the Medicaid limit, and may get a qualified health plan with federal tax credits through Kynect, the state-based marketplace.

"So, we're going to work really hard to make sure that people understand if you're losing your Medicaid eligibility, but you qualify for a QHP on the state-based exchange, and potentially advanced premium tax credits to make it affordable, then you can find coverage on the exchange. And we're gonna work really hard to make sure people understand that," Judy-Cecil said.

"Our focus is going to be on ensuring no unnecessary administrative terminations. And what that means is . . . if we need information from them, we want to make sure they get it to us, we want to verify that they're no longer eligible. We don't want somebody who is eligible to drop off because we didn't get something back. So we're gonna work really hard to make sure that they're covered. We're also gonna work on those folks that [are] no longer eligible and make sure that they get moved to plans that keep them covered."

Judy-Cecil added that about 80% of Kentuckians on Medicaid can go through an automatic renewal process because they know what their income is and if it is too high.

Most Ky. counties still have low Covid-19 risk, but number of high-risk counties rose last week and new-case rate is first in nation

Centers for Disease Control and Prevention map

This story has been updated.

By Melissa Patrick
Kentucky Health News

While most Kentucky counties continue to have a low risk from Covid-19, the number of counties with a high risk went back up to 11 this week, after dropping to five in last week's Centers for Disease Control and Prevention report.

Gov. Andy Beshear acknowledged that Kentucky's case numbers continue to fluctuate each week and Covid-related hospitalizations remain low, but the death rate remains high, making it important to get vaccinated.

"Folks, Covid is still out there," Beshear said at his weekly news conference Thursday, held before the latest CDC report was released. "We still lose typically 40-plus people a week. So please, if you haven't gotten vaccinated or boosted, please consider it."

On Saturday, Feb. 4, The New York Times ranked Kentucky's new-case infection rate for the week first in the nation, barely ahead of Rhode Island, Puerto Rico and Alabama, even though the rate had declined 27 percent in the last two weeks.

The CDC map, which is based on Covid-19 cases and hospital numbers to determine risk, shows 40 counties at medium risk, shown in yellow; and 69 at low risk, shown in green. High-risk counties, shown in orange, are Barren, Adair, Cumberland, Clinton, Breathitt, Letcher, Greenup, Carter, Boyd, Lawrence and Martin. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Centers for Disease Control and Prevention map

The CDC also has a transmission level map, largely used by researchers and health-care facilities, that shows the level of virus spread in each county, at one of four levels. The map shows 10 counties had a moderate level of transmission, down from 26 the week before, and the rest had either substantial or high levels of transmission.  

An example of how these transmission levels are used by hospitals became evident this week when Norton Healthcare reinstated masking rules for its Louisville-area hospitals, based on the CDC's transmission report and the recommendation of its accrediting agency.

"Norton Healthcare continues to evaluate local and national data and the current status of Covid-19 cases throughout our community to guide our protocols and practices," a hospital spokesperson said in a statement. "Jefferson County has experienced continued community transmission of Covid-19 as detailed in the CDC's Covid Data Tracker that lists Louisville as being at a 'high' level of transmission."

Second Appalachian Gathering for Recovery Solutions March 9

The second Appalachian Gathering for Recovery Solutions aims to provide opportunities for in-person communication and networking among recovery programs and resources in Eastern Kentucky. It is a free, one-day gathering set for March 9, at the Union College campus in Barbourville.

Scheduled speakers are Tim Robinson, CEO of Addiction Recovery Care; Dr. Al J. Mooney, author of The Recovery Book; Geoff Wilson, president of the Kentucky Association of Addiction Professionals, and other experienced practitioners from Appalachia, who will discuss advances in substance-abuse recovery.

The gathering will use technology to reach a broader audience interested in all aspects of the recovery pipeline. Participants can choose and attend the panels which are of most interest to them. Register here.

Norton Healthcare makes more families eligible for financial aid

Norton Healthcare, which has five hospitals in Louisville and is building another, it making more families eligible for its financial assistance program, raising the income limit from 300% of the federal poverty threshold to 350% That extends eligibility to families of four with a household income up to $105,000.

"Additionally, individuals now can apply in advance to participate in the expanded financial assistance program," Norton said in a news release. "By completing the qualification process ahead of time, it will remove the barrier that some experience when asked to discuss financial status matters at the point of care. Previously, families would complete an application after receiving treatment. . . . For those with income that excludes them from this program, Norton Healthcare has additional resources available to financially assist patients."

Application can be made at NortonHealthcare.com/FinancialAssistance or by a paper application, available by calling 502-479-6300. Approval is valid for one year, and those eligible can re-apply each year.

“By providing this proactive approach to our Financial Assistance Program, families across the region can put their health first without the burden of worrying about the financial aspects at the point of care,” Norton President and CEO Russell F. Cox said. “Everyone in our community deserves access to quality health care. We are committed to creating initiatives and programs that remove barriers and work toward eliminating challenges for those seeking care.”

Risk is lower, but it's NOT time to resume pre-pandemic life, New York doctors write in one of the nation's top medical journals

An editorial in the New England Journal of Medicine by Dr. Wafaa M. El-Sadr, Columbia University; Dr. Ashwin Vasan, New York City Department of Health and Mental Hygiene; and Ayman El-Mohandes, City University of New York

Wafaa El-Sadr, M.D.

We’ve come a long way. From the early, terrifying days of a rapidly spreading deadly infection to the current circumstances in which — despite a recent steep rise in transmission rates — Covid-19 has, for many people, become no more than an occasional inconvenience, involving a few days of symptoms and a short isolation period. It’s clear that for many, if not most, people, SARS-CoV-2 infection no longer carries the same risks of adverse outcomes as it did in the early months of the pandemic. These shifts have led to a widespread assumption, fueled by political and economic priorities, that the pandemic is behind us — that it’s time to let go of caution and resume prepandemic life.

The reality, however, would starkly contradict such a belief. Covid-19 currently results in about 300 to 500 deaths per day in the United States — equivalent to an annual mortality burden higher than that associated with a bad influenza season. In addition, many people continue to face severe short- or long-term Covid-19 illness, including people who lack access to vaccines or treatment and those with underlying conditions that impair their immune response to vaccines or render them especially vulnerable to Covid-associated complications. The ever-looming threat of the evolution of a new variant, one that can evade our vaccines and antivirals, remains very real. These facts support the assumption that SARS-CoV-2 will continue to play a major role in our lives for the foreseeable future. This new reality compels us to navigate a more complex social, economic, political, and clinical terrain and to take to heart the lessons learned from the Covid-19 response thus far — both the successes and the missteps.

To date, monitoring of the effects of Covid-19 has rested on several epidemiologic and clinical measures, which have shaped the recommended or mandated protective actions. Most commonly, these measures have included estimated rates of Covid-19 cases, hospitalizations, and deaths; monitoring has also been conducted of circulating SARS-CoV-2 variants and their susceptibility to available vaccines and treatments.

Yet in the current situation, some of these traditional measures have limited value. For example, the availability of rapid antigen tests that can be conducted at home — the results of which often aren’t captured by public health surveillance systems — challenges the validity of reported case numbers and transmission rates in some jurisdictions. There is therefore a need for unbiased monitoring of transmission and infection rates by means of regular testing of sentinel populations or randomly selected representative samples of the general population. Hospitalization and death rates are certainly more reliable measures than case rates, but these measures are limited by the fact that some hospitalized patients with SARS-CoV-2 infection have been admitted for other reasons and only incidentally tested positive. Furthermore, hospitalization and death are distal outcomes, so their rates have limited value for triggering early action to control the spread of infection and averting the consequences of a surge in cases. Other measures have gained prominence and now play a critical role in defining risk for infection or severe disease. Vaccine and booster coverage and availability and utilization of treatment for Covid-19 are critical variables that affect both the risk of severe illness or death from SARS-CoV-2 and health system capacity and access.

We have gained a deeper appreciation of the breadth of the pandemic’s effects, beyond its obvious health effects. These effects have included loss of employment or housing, disruption of educational systems, and increased rates of food insecurity. Many of these negative social and economic effects were unintended results of mitigation measures, including stay-at-home orders, the shutting down of public venues, and transitions to remote learning. Although these measures were appropriate at the time, their effects weren’t evenly distributed, with some communities facing disproportionate hardship, particularly historically marginalized racial and ethnic groups and communities with limited social and economic reserves. It is thus necessary to take into account the ways in which public health recommendations and policies may differentially affect various subgroups of the population. Government and nongovernmental entities need to create clear pathways for vulnerable populations to obtain access to the resources they need, including masks, vaccines, no-cost treatment, direct economic assistance, supplemental food, rent abatement, and Internet access to support virtual learning and remote access to health services. Such an approach requires that the federal government continue to invest in the Covid-19 response, since private-sector investment will be insufficient to meet all needs.

One of the key challenges that the public-health community faces as the pandemic evolves is the need to move away from universal recommendations, or population-wide prevention policy, toward a more differentiated or tailored approach — one that takes into account the characteristics of various communities and the pathogen. Relevant characteristics may include those that influence virus transmission or clinical outcomes, such as vaccine and booster coverage and risk factors for severe outcomes, including chronic medical conditions, racism and discrimination based on ethnicity, and lack of adequate health insurance. The implementation of tailored guidance for specific populations, however, is complicated by the legacy of glaring health disparities, the threat of stigmatization, and prevailing mistrust of authorities in some communities. Health-equity and antiracist principles and insights from the fields of health communication and behavioral science must therefore be taken into account from the start in the development and dissemination of recommendations and the implementation of programs and policies.

There is much to lament in the politicization of the Covid-19 pandemic, the spread of disinformation and misinformation, the deep divisions within the U.S. population and, globally, in people’s perceptions of the pandemic and willingness to trust guidance and embrace protective measures. These divisions should inspire a re-examination of the reasons that some public-health recommendations fell flat, in addition to an acknowledgment that political expedience played a role in sowing mistrust. As the pandemic evolves, as the measures of its effects become more complex, and as guidance requires greater tailoring to specific populations, effective communication becomes even more important. Providing clear guidance, including explaining the rationale for various recommendations, acknowledging the social and economic trade-offs involved in complying with them, and offering people the resources they will need to effectively manage these trade-offs, would go a long way toward enabling the adoption of those recommendations.

Most important, attention to the engagement of trusted community leaders and spokespeople is required, as is listening authentically to communities from the start. Rather than focusing solely on what is being recommended, it’s equally important for public health leaders to focus on how recommendations are communicated and disseminated. Early engagement of community representatives is critical so that various aspects of anticipated guidance can be discussed in detail, including rationales, trade-offs, and the most appropriate communication channels and formats. Engagement must not only come in the form of an emergency response, but must involve a consistent presence, which can then be leveraged and activated further during times of urgent need.

The current moment in the Covid-19 pandemic is a pivotal one. There is an urgent need to confront a future in which SARS-CoV-2 will remain with us, threatening the health and well-being of millions of people throughout the world. At the same time, it’s important to acknowledge that objectively we are in a better place with regard to the virus than we’ve ever been and that in fact many people believe the pandemic is behind us. This reality compels us to avoid using alarmist language and to offer valid and feasible solutions to bring people along to a new, nonemergency phase of the pandemic. How we craft our policies, programs, and associated messaging in this context and who delivers the messages is as important as ever.

KET panel discusses bill to legalize medical cannabis in Kentucky

Renee Shaw discusses legislation introduced to legalize medical marijuana in Kentucky on KET's Kentucky Tonight with guests (L-R) Jaime Montalvo, founder of Kentuckians for Medicinal Marijuana; Sen. Phillip Wheeler, R-Pikeville; Dr. Danesh Mazloomdoost, an anesthesiologist and degenerative specialist; and Ed Shemelya, coordinator of the National Marijuana Initiative. 

By Melissa Patrick

Kentucky Health News

Proponents and opponents of a bill to legalize medical marijuana in Kentucky were on KET's Jan. 30 edition of "Kentucky Tonight," with proponents saying Kentuckians are calling for legal access to cannabis and opponents saying doctors shouldn't be asked to prescribe or recommend a substance based only on anecdotal evidence that it works. 

"Passage of the medical marijuana law isn't going to just magically bring marijuana to Kentucky. It's already here," Jaime Montalvo, founder of Kentuckians for Medicinal Marijuana, told KET host Renee Shaw. "What we as patients are asking [for] is the regulation of cannabis so that we can go to a safe environment and purchase a product that is clean from people who are regulated by the state, you know, and are not there to sell us other potentially dangerous chemicals." 

Dr. Danesh Mazloomdoost, an anesthesiologist and degenerative specialist, told Shaw that it would be a stretch to define marijuana or cannabis as medicine, because research does not yet support that. 

"It has medicinal properties, but to call it medicine is a little bit of a misnomer because medicine is a product or compound that we know the pharmacology, the pharmacodynamics," he said. "In other words, what impact it has on the body; what conditions . . . it's applicable to; what are some of the contraindications; what are the risks? And we don't really have any of that information. We don't know what dosages are appropriate. We don't know what an overdose or what excessive dosages are. So to call it medicine conveys a false sense of security."  

The Kentucky House of Representatives has passed two medical marijuana bills, most recently in 2022 with a vote of 59-34. Both bills died in the Senate. Because the bills keep getting shut down in the Senate, this year's bill, Senate Bill 47, sponsored by Sen. Stephen West, R-Paris, will start there. 

Gov. Andy Beshear's Medical Cannabis Advisory Committee reported that 98.6% of Kentuckians who offered an opinion on its website supported medical marijuana. A Kentucky Health Issues Poll for the Foundation for a Healthy Kentucky found that 90% of Kentuckians favor medical cannabis.

Shaw asked Sen. Phillip Wheeler, R-Pikeville, a primary co-sponsor of the bill, if he thought the medical marijuana bill would pass this year. 

Wheeler said, "I hesitate to speak for anybody but myself and the various co-sponsors of the bill, but I am optimistic that this may be the year that you see some action on it in the Senate. We have several new members, some of whom seem to be more open to the idea of medical cannabis." 

Earlier in January, Senate President Robert Stivers, who has long said more research is needed before a medical marijuana bill is passed, showed the first sign that he might be willing to compromise on this issue when he told Shaw Jan. 9 that he might be willing to approve medical marijuana in Kentucky on a very limited basis, to relieve patients' pain at the end of their lives. 

Ed Shemelya, national coordinator of the National Marijuana Initiative, said he opposed passing a medical marijuana law and instead said to allow the recent federal Medical Marijuana and Cannabidiol Research Expansion Act to do its job. 

"What that act did is . . . remove most of those barriers so we can conduct legitimate research into not only the beneficial components of this plant, but also the harmful consequences of it," Shemelya said. "Absent that, if we were making a legislative decision to determine the efficacy and safety of a substance that isn't grounded in science and isn't rounded in research, is grounded in anecdotal stories that may or may not be correct."  

Further, he said diversion is occurring in each of the 37 states that medical marijuana is legal, along with increased incidences of impaired driving; people are experiencing THC psychosis from high-potency products; and treating cannabis as medicine will add to young people's misconception that it is safer than alcohol. 

Both sides criticized Beshear's executive order that used his pardon power to allow people with a medical provider's statement saying they have at least one of 21 specified medical conditions to possess up to eight ounces of cannabis for medical purposes in Kentucky, if bought legally in another state. The only adjoining state that currently allows such purchases by Kentuckians is Illinois.

Montalvo, who said he had just gotten a letter of confirmation from his doctor that he has multiple sclerosis, one of the medical conditions included in Beshear's order, told Shaw that he fears the executive order could result in some patients thinking cannabis is legal and that it could lead to an influx of cases in the court system if police officers can't decipher what is legal or not. 

"I fear that the executive order was well intentioned, but has led or will lead to many more problems," he said. 

Wheeler told Shaw that while he shares the governor's compassion for people wanting cannabis to treat afflictions, he was disappointed in Beshear for not recognizing it is the legislature's job to set the policy and the governor's job to execute it. He also said the order creates confusion among law enforcement and that the use of a prospective pardon creates a "slippery slope" in a state where marijuana possession is illegal. But he said he didn't think the governor's order would impact the bill's process.

Beshear said he was prompted by the lack of legislative action. Wheeler said, "Sometimes it takes many sessions to get [a bill] through and that's part of our constitutional democracy. And I don't think it's appropriate for this governor or any governor to circumvent that by things such as the executive order that he signed." 

Wheeler also revealed several components of the 155-page medical marijuana bill. He said it creates a safe marketplace to buy the products; does not include a list of conditions required to make a person eligible to receive it; requires a time-limited supply; allows flexibility for doctors and pharmacists; says cannabis can't be grown independently; allows children to use it with parental consent; allows only doctors and doctors of osteopathic medicine to prescribe it; directs the Medical Licensure Board to handle cases of prescribing abuse; and gives oversight to the Department of Alcoholic Beverage Control, which would be renamed the Department of Alcoholic Beverage and Cannabis Control. He also said cannabis won't be taxed.  

The hour-long show opened with Preston Cantwell of Rineyville in Hardin County, who was diagnosed with epilepsy when he was 4, telling the story of how medical cannabis has stopped his seizures, which several prescribed medications had failed to do. He said CBD, or cannabidiol, worked to reduce his seizures for a couple of years, but it eventually stopped working. He now uses "whole plant cannabis" and hasn't had a seizure since 2019. "It has basically, just entirely cured it," he said. 

Julie Cantwell, his mother and founder of Kentucky Moms for Medical Cannabis, told KET that every few months they drive to Michigan to get their cannabis, which costs thousands of dollars. "We would like to be able to spend that here," she said.