Thursday, April 19, 2018

McConnell files bill to better inform doctors and pregnant women about alternatives to opioids, boost grant money for it

Senate Majority Leader Mitch McConnell of Kentucky introduced a bill Thursday to require the Centers for Disease Control and Prevention to develop educational materials to give doctors and expecting mothers better information about alternatives to opioids, and to authorize more money for a competitive federal grant to help organizations address that aspect of the opioid epidemic.

The Louisville Republican said in a floor speech that the would-be Protecting Moms and Infants Act “continues our years-long efforts to protect the most vulnerable. . . . Medical professionals, law enforcement officials and many others across Kentucky are working every day to bring an end to the misery of the opioid epidemic. This legislation will continue that fight.” 

McConnell said Second District U.S. Rep. Brett Guthrie, R-Bowling Green, is sponsoring companion legislation in the House.

Wednesday, April 18, 2018

Poll: 24% of Kentucky adults know someone with a pill problem and 16 percent know someone with a heroin or meth problem

By Melissa Patrick
Kentucky Health News

Whether it's the misuse of prescription pain relievers, heroin or methamphetamine, the latest Kentucky Health Issues Poll findings indicate that many Kentuckians have a drug problem.

The poll, conducted Oct. 24 to Dec. 2, found that nearly one in four Kentucky adults, or 24 percent, said they knew someone who had experienced problems as a result of prescription pain relievers. That number has remained largely the same since 2013, but it indicates the depth of the problem.

"Misuse of opioids such as OxyContin, Vicodin, Percocet and codeine remains a critical public health and safety issue for Kentucky," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll, said in a news release. "Not only are we losing more than 1,600 lives a year to overdoses, we are facing incredible losses in quality of life, workplace productivity, and business competitiveness."
The good news: Kentuckians said they are being prescribed pain relievers less often. In 2011, the poll found that 55 percent of Kentucky adults said they had been prescribed a pain reliever in the past five years; in the latest poll, the number dropped to 34 percent.

"Perhaps all of the education that's being done about the dangers of over-prescribing narcotic pain relievers is starting to make a difference, both in the number of people getting prescriptions and the amount of the pain medication they receive," Chandler said.

Seven percent of those polled said they weren't prescribed enough pills to control their pain; 21 percent said they were prescribed the right amount; and 6 percent said they were prescribed more than needed.

The poll also found regional differences in prescribing. The highest percentage of Kentucky adults who said they had been prescribed a pain reliever in the past five years was in the Louisville area (41 percent) and Northern Kentucky (40 percent). In was 37 percent and 36 percent in Lexington and Western Kentucky, respectively. The lowest share, 26 percent, was in Eastern Kentucky. That is the region where problems with drug addiction and overdoses are greatest, so the numbers could indicate that users are using illegal drugs or getting prescription medicines from illegal sources.

Click on any chart to view a larger version of it.
The poll found that 16 percent of Kentucky adults said they knew someone who had problems as a result of using methamphetamine or heroin. Both numbers were unchanged from the prior poll.

The poll shows that problems with heroin increased steadily between 2013 and 2016, but remained steady over the last year. Meth problems have remained steady since 2013.

Responses to these questions also varied by region with the percentage of adults who said they knew someone with problems due to heroin highest in Northern Kentucky (29 percent) and lowest in Western Kentucky (11 percent). The percentage of adults who said they knew someone with problems due to methamphetamine was highest in Eastern Kentucky (22 percent) and lowest in the Lexington area (13 percent).

Since 2013, the percentage of Kentucky adults who said they knew someone with a heroin problem has remained about the same in Northern Kentucky, which is often called ground-zero for this issue. However, this number has risen significantly in Louisville (from 8 percent in 2013 to 23 percent in 2017), Lexington (from 9 percent to 18 percent) and Eastern Kentucky (from 8 percent to 14 percent), with a lesser increase in Western Kentucky (from 7 percent to 11 percent).
Since 2013, Kentucky adults reporting they knew someone with a meth problem increased in Louisville (from 6 percent in 2013 to 16 percent in 2017) and Northern Kentucky (11 percent to 17 percent) and declined in the Lexington area (19 percent to 13 percent). The numbers remained about the same in Eastern and Western Kentucky.

"This poll is yet another piece of evidence that Kentucky's focus on resolving the drug abuse crisis must continue," Chandler said. "And it must involve multiple sectors of our society working together to engage all individuals struggling with addiction."

The news release about the poll notes that a National Vital Statistics Report shows meth use may be rising to problematic levels similar to heroin use; the National Institute on Drug Abuse reports that Kentucky had the fifth highest death rate due to drug overdose in 2016; and a CDC report found opioids, including prescription drugs, are the most common cause of overdose deaths.

Kentucky passed a law last year that generally limits painkiller prescriptions to a three-day supply if prescribed for acute pain, which lines up with the Centers for Disease Control and Prevention's guidelines for prescribing opioids. The limit does not apply to prescriptions for chronic pain.

This year the legislature passed a law to require pharmacists to tell patients how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize the drugs for disposal, or provide on-site disposal. Nearly 80 percent of Americans using heroin, including those in treatment, reported misusing prescription opioids first, according to the National Institute on Drug Abuse.

The poll was funded by the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,692 Kentucky adults via landlines and cell phone. The poll's margin of error for each statewide result is plus or minus 2.4 percentage points.

Tuesday, April 17, 2018

Index of readiness for disasters and health emergencies has Ky. about same as U.S.; slips in environmental, occupational health

By Melissa Patrick
Kentucky Health News

Is Kentucky ready to manage a natural disaster or a health emergency? Just as much as the nation as a whole is, according to a recently released Robert Wood Johnson Foundation report.

The annual report, called the 2018 National Health Security Preparedness Index, gives Kentucky an score of 7.1 on a 10-point scale for preparedness, the same as the national average. The state and nation saw a slight improvement from the previous year's score, following continuous improvements since 2013.

"Five years of continuous gains in health security nationally is remarkable progress," Glen Mays, who leads researchers at the University of Kentucky who develop the index, said in a news release. "But achieving equal protection across the U.S. population remains a critical unmet priority."

Kentucky was one of 11 states more or less at the national average. Those below average were largely in the Deep South, Southwest and Mountain West regions. Maryland had the top score of 8.0 and Alaska and Nevada shared the bottom number of 6.4.

Such numbers are becoming more important. "The United States experienced the most active and expensive year on record for disasters and emergency events in 2017, with total economic damages exceeding $300 billion," the report begins, adding that the "uneven pace" of improvement for health security across the U.S. is "leaving large and growing segments of the American population under-protected."

The index analyzes 140 measures, such as the number of pediatricians, flu-vaccination rates, bridge safety and food and water safety, to calculate a composite score of health security for each state and the nation as a whole.

The measures are then grouped into six larger categories including, health security surveillance; community planning and engagement; information and incident management; health-care delivery; countermeasure management; and environmental and occupational health.

Kentucky improved or stayed about the same as the national averages in all but one of those broad areas -- environmental and occupational health, which measures state's ability to maintain the security and safety of water and food supplies, to test for hazards and contaminants in the environment, and to protect workers and emergency responders. Kentucky's score for this measure dropped about 5 percent from the prior year, to 6.0. The national score is 6.6.

Kentucky saw its greatest improvement in health security surveillance, which rose 13.2 percent between 2013 and 2017. This measure looks at the state's ability to monitor and detect health threats, and to identify where hazards start and spread so that they can be contained rapidly. Kentucky's score for this domain was 8.6, compared to the national average of 8.1.

The state's lowest score, 5.2, is in health-care delivery, but that is the same as the national average. This category measures a state's ability to ensure access to high-quality medical services across the continuum of care during and after disasters and emergencies.

Suggestions from the report to to improve health security include: improving data sources and metrics; strengthening networks and coalitions; improving workforce policies, like offering paid leave and health insurance; improving health care delivery preparedness; assuring a dedicated and adequately resourced health security emergency response is in place; assuring adequate funding for an established health security infrastructure; and allowing for flexibility in the existing health security funding mechanisms.

Monday, April 16, 2018

New Medicaid rules would lead to many more people losing coverage than Bevin administration has estimated, critics say

Changes in the state Medicaid program, to be phased in starting July 1, would lead to many more people losing health coverage than the state has estimated, 43 academic experts say in a friend-of-the-court brief filed in a lawsuit challenging federal officials' approval of the changes.

The experts argue that the changes are "likely to remove at least twice as many beneficiaries in the first year while barring initial enrollment for countless others," then go on to forecast much higher numbers. The Bevin administration disputes the projection.

The state has estimated that the changes will cause about 20,000 fewer people to have Medicaid coverage in the first year than would have been the case without the changes, rising to a total of 97,000 in the fifth year.

Critics of the changes say the numbers are likely to be higher, based on recent experience with work requirements in the Supplemental Nutrition Assistance Program that are similar to the new rules requiring work, job training or community service by adults who are not disabled, medically frail, pregnant, or primary caregivers.

SNAP, formerly known as food stamps, requires able-bodied adults 18 to 49 without dependents to work at least 20 hours a week or lose benefits after three months in any three-year period. The requirement was waived in most of the country from 2009 to 2015, due to high unemployment; some states have re-instituted it in some counties.

In their court brief, the academic experts cite examples in Georgia, Maine and Alabama, where SNAP participation fell from 62 to 85 percent in counties where work requirements were reinstated, and assert: "Viewed from that lens, of the 350,000 people subject to the work requirements in Kentucky, Medicaid losses will be much higher and faster than the Commonwealth predicted, between 175,000 and 297,500 losing coverage in the first year."

On the blog of Health Affairs, a policy journal, Erin Brantley and Leighton Ku cite the same data but add cautionary notes: "There are certain differences in the work requirements in SNAP and Medicaid," and "Improving economies might explain a small portion of the declines" in SNAP participation. "Impacts in other states and areas may differ. In some cases, the reports are unclear about which SNAP beneficiaries are included in the estimates of those subject to work requirements."

Still, the writers conclude that the data "suggest that Medicaid enrollment could plummet rapidly" in Kentucky due to the program's new requirements.

Gov. Matt Bevin's deputy chief of staff for policy, Adam Meier, said in an e-mail that while he couldn't speak for the methodologies used, the differences could be because the Medicaid benefit is so much higher than the SNAP benefit.

"The differences could be attributable to the fact that the state spends approximately $6,700 on average per Medicaid eligible individual—thus it is [a] much richer benefit than SNAP, so there is more incentive to participate," he said.  "Further, it may also be due to the broad spectrum of qualifying activities that can be done to satisfy Kentucky’s community engagement requirement, making it easier to satisfy than the basic SNAP employment and training requirements."

Meier said the SNAP enrollment declines cited weren't simply due to non-compliance, but also because many had improved their personal situation and no longer needed, or qualified, for the program.

"For example, in Kansas, SNAP able-bodied adults without dependents (ABAWDs) subject to the requirements experienced a 127 percent increase in their income within one year of leaving, the average income among those working were now above the poverty line, and enrollees’ average income more than doubled. In addition, nearly one-half of Kansas ABAWDs were employed within one quarter of leaving SNAP, and the amount of time ABAWDs spent enrolled in SNAP was cut in half," he said.

Meier also pointed out that Kentucky's new Medicaid plan does not make any changes to initial eligibility or application requirements, so no one will be barred from enrollment, as the court brief suggests.

Bevin's administration estimates that about half the estimated 350,000 people who will be subject to the work rules are already meeting them. It says an unspecified part of the enrollment decline will come from people failing to meet reporting requirements.

The rules will be phased in, beginning in areas with low unemployment, administration officials have said.

Sunday, April 15, 2018

Legislature tosses health departments and mental-health centers a budget lifeline; bills on disposal of opioids become law

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – As it wrapped up its business, the Kentucky General Assembly threw a financial lifeline to health departments and mental-health centers, passed a telehealth bill without an amendment favored by insurance companies, and overrode the governor's veto of a drug-disposal bill.

Budget: In a revision of the budget it passed earlier, the legislature froze for one year the pension contributions of health departments and 11 of the state's 14 community mental health centers, which were facing increases in pension payments of 49.5 to 83.4 percent, averaging 69 percent.

That would have been a double whammy with the 6.25 percent across-the-board cut proposed by Gov. Matt Bevin and included in the budget, which is likely to force cuts in personnel and services.

Bevin could veto the revision bill, but he suggested Friday evening that it was making the budget better. And he indicated that he would still have to make cuts because the budget will be unbalanced. Legislative leaders have disputed that.

Home care for the disabled: In a rare gain among programs, the budget adds $10.5 million to the General Fund to generate an extra $24.6 million in federal Medicaid money each fiscal year for the Supports for Community Living program, which enables developmentally and intellectually disabled Kentuckians to receive care in homes rather than health-care facilities.

The money will "raise reimbursement rates to SCL service providers who have not seen an increase since 2004, even as costs have risen 27 percent through inflation since that time," says the Kentucky Center for Economic Policy. "The stagnant payment rates have contributed to a 45 percent turnover rate among providers and a 41 percent decrease in services offered to intellectually and developmentally disabled Kentuckians."

Telehealth: By a vote of 65-20, he House gave final passage to SB 112aimed at increasing access to health care and saving money by requiring the state to develop policies on health care by telecommunication –including a reimbursement model, with similar expectations for the public insurance market. The House did not consider an insurance-company floor amendment filed by Rep. Jim Gooch, R-Providence, that would have removed a key provision, requiring telehealth visits to be paid for at same level as regular visits unless otherwise negotiated. Bevin could still veto the bill.

Drug disposal: The legislature overrode Bevin's veto of House Bill 148, sponsored by Rep. Addia Wuchner, R-Florence, to shift ownership of controlled substances from deceased hospice patients to the hospice for disposal. Bevin's veto message said the bill was contrary to federal law and U.S. Drug Enforcement Agency policy, but Senate President Robert Stivers cited a DEA memo that cleared the way for the bill.

Bevin allowed to become law without his signature Senate Bill 6, sponsored by Sen. Alice Forgy Kerr, R-Lexington, to make pharmacists tell customers how to safely dispose of unused opioids and other controlled substances, and either provide or offer to sell them a product designed to neutralize drugs for disposal, or provide on-site disposal. More than 70 percent of all opioid addictions result from misuse of prescription drugs.

Other health bills: In the days before the legislature reconvened to consider vetoed bills and pass others, Bevin signed several health-related bills into law, including:

SB 5, sponsored by Sen. Max Wise, R-Campbellsville, to put the Medicaid program in charge of reimbursement rates for pharmacists. Rates are now set by pharmacy benefit managers, firms hired by managed-care organizations (mainly insurance-company subsidiaries). The bill sets reporting requirements for PBMs and MCOs and the $1.7 billion a year they get from the state. It also would allow the Medicaid program to approve contracts and fees between MCOs, PBMs and pharmacists.

HB 463, sponsored by Rep. Michael Meredith, R-Brownsville, to prohibit PBMs from requiring clients to make a co-payment that is higher than a lesser cash-payment amount, and keep them from penalizing a pharmacy for telling patients if that option is available. It is called the "clawback" bill, because PBMs "claw back" the difference between the higher co-pay and the lower price of the drug.

SB 71, sponsored by Sen. Steve Meredith, R-Leitchfield, would require the inclusion of abstinence only education in any sex-ed classes taught in Kentucky. Kentucky has no comprehensive sexual health education standards; the state Department of Education is reviewing proposed rules.

Failed bills: Health-related bills that were poised for passage but did not make it included SB 95, sponsored by Kerr, to require health insurers to cover standard fertility preservation services for patients who have become infertile by means of surgery, radiation, chemotherapy or any other medical treatment affecting reproductive organs and processes; and SB 149, sponsored by Sen. Julie Raque Adams, R-Louisville, chair of the Senate Health and Welfare Committee, to establish an advisory council for palliative care, given to make patients with incurable illnesses more comfortable.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Saturday, April 14, 2018

In 1990-2016, Ky. had 4th highest increase in risk of death, 2nd biggest rise in death risk from mental or substance-use disorders

By Al Cross
Kentucky Health News

Life expectancy in Kentucky increased from 1990 to 2016, but by only 1.4 years, while it increased 4.4 years nationwide, so the state fell from 42nd to 46th in life expectancy, according to "the most extensive state-by-state U.S. health study ever conducted," as described by the Institute for Health Metrics and Evaluation at the University of Washington. The institute conducted the study and published it in the Journal of the American Medical Association.

The lagging life expectancy is driven largely by premature deaths, between age 20 and 55. From 1990 to 2016, the risk of premature death rose more than 10 percent in five states: West Virginia, Oklahoma, New Mexico, Kentucky and Wyoming. Kentucky rose from 12th to seventh in the estimated years of life lost from premature death; states ranking ahead of it, in ascending order, were Arkansas, Oklahoma, Louisiana, Alabama, West Virginia and Mississippi.

The study compared the risk of death from various factors. The risk of death from mental and substance-use disorders increased more in Kentucky from 1990 to 2016 than any state but West Virginia, another indicator of the depth of the opioid epidemic in Central Appalachia. Ranked by years of life lost from various causes, opioid use rose nationally from 22nd in 1990 to to 15th in 2016. The age-standardized U.S. death rate from opioids rose 343 percent, far more than any other factor.
In overall life expectancy, several states fell much farther in the rankings than Kentucky did. Kansas fell to 30th, from 12th; Idaho dropped to 23rd from eighth; Indiana went to 42nd from 27th; and South Dakota fell to 25th from 11th.

The greatest gains in rank were by California, which moved up to second from 24th; New York, which rose to fifth from 39th; New Jersey, which moved to eighth from 26th; and Maryland, which is now 21st after being ranked 38th.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Friday, April 13, 2018

Legislature overrides vetoes to pass tax bill; tobacco advocate says cigarette tax will have 'very, very small' impact on growers

By Al Cross
Kentucky Health News

FRANKFORT, Ky. – Kentucky's cigarette tax is going up by 83 percent in July, to $1.10 a pack, but the impact on Kentucky tobacco farmers will be "very, very small." So said the legislature's leading tobacco advocate after Republican legislators overrode Republican Gov. Matt Bevin's vetoes of the omnibus tax bill and the budget it finances.

Sen. Paul Hornback
Republican Sen. Paul Hornback of Shelbyville, a longtime tobacco grower, was one of two senators who voted for the surprise tax measure on April 2 but voted against it on Friday, April 13. The other was Sen. Joe Bowen, R-Owensboro.

Hornback, asked afterward why he switched, recalled saying when he voted the first time that it was "a bad revenue bill" that weighed heavily on agriculture, particularly tobacco, "because the largest single tax it creates is the tobacco tax, the cigarette tax."

Challenged on whether the tax would have any impact on Kentucky's 4,000 or so tobacco farmers, Hornback smiled and said, "Well, it sounds good." He added, "It does have some. It's very, very small." Tobacco trades in a world market.

The tax may not have much effect on Kentucky's second-in-the-nation smoking rate, either. Anti-smoking advocates called for a $1-a-pack increase, saying that cigarette companies will keep smokers hooked by offering coupons and discounts when the tax hike hits, then gradually raise their prices.

Hornback said a more significant factor in his vote was that estimates of revenue from the higher tax were based on last year's sales and did not seem to take into account a likely loss in Kentucky sales to residents of states where the tax is or will be lower, such as Indiana. "I don't know what that number is, but it's a big number," he said.
Original map from Campaign for Tobacco-Free Kids, adapted by Kentucky Health News
Hornback said he also switched on the bill because it wasn't the comprehensive tax reform the state needs. He said some Republicans pushing for an override argued that the bill was just "one bite of the apple" and the politically touchy subject could be tackled again. He is skeptical.

"I don't think we have the will to go back and re-address this issue of comprehensive tax reform anytime in the foreseeable future," Hornback said. "That's my concern. If we're gonna do it, we should have done it. We ought to do it right, and we didn't do that."

Bowen said he switched to opposing the bill because "I had buyer's remorse from the time I cast an 'aye' vote, and I was glad to be able to go get a mulligan" -- a golfer's term for a replacement shot.

"Picking winners and losers has never worked for me, and that was a big-time picking winners and losers" measure, he said, due to its selective application of the sales tax to certain services. "It's the hardest-working people who are going to be hit the most with that; you know, people who drive an old car need the most repairs."

Democratic senators, none of whom voted for the bill, made that and similar points. Minority Leader Ray Jones of Pikeville called it "trickle-down economics at its finest."

Bowen said, "I was gonna get up and explain my vote but once Ray Jones made all my arguments, I wasn't going to reinforce what he had to say. It's a weird process, isn't it?"

The cigarette tax will fall more heavily on the poor because they are more likely to be smokers.

Bowen said he generally favors consumption taxes such as the sales tax over income taxes, "but we didn't take that far enough. We just cherry-picked it, and I had a lot of problems with it."

Bowen said he made his position known to other Republican senators in a conference call the night before. He said Republican leaders didn't ask him to reconsider.

Supporters of the tax bill had no votes to spare, since it had passed with a bare majority, but two other Republicans switched form opposing the bill April 2 to supporting it on the override vote.

Sen. C.B. Embry of Morgantown said in a floor speech that he is a former teacher and had been lobbied by teachers from Butler, Ohio, Muhlenberg and Hopkins counties, and "I'm going to stand with the teachers of the Sixth District."

The other senator who switched to support the bill was Wil Schroder of Wilder, who has a Democratic opponent for re-election. He said in an interiew that "I wasn't confident the first time" that the tax bill had gone through a proper deliberative process, but resolved those concerns and voted for it on substance.

The final and decisive vote to pass the bill into law was cast by Senate President Robert Stivers, R-Manchester, who had managed its initial passage. He said it will fill a funding gap that has been created by politicians in both parties over many years, and taxes many of the same services proposed by a commission appointed by the last governor, Democrat Steve Beshear.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Thursday, April 12, 2018

U of L therapy provides hope for victims of movement disorder

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

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

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

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

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

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

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

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

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

Wednesday, April 11, 2018

Paducah expands smoking ban to e-cigs, private workplaces

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

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

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

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

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

Tuesday, April 10, 2018

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

Adams and Jody Jaggers of Kentucky Pharmacists
Association's Pharmacy Emergency Preparedness
(Photo by Mary Meehan, Ohio Valley ReSource)
The U.S. surgeon general has issued the first health advisory in 13 years, calling for everyone who has family or friends with any risk of opioid overdose to get naloxone, a drug that can reverse an opioid overdose, and learn how to use it. More than 1,400 Kentuckians died from an overdose in 2016.

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

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

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

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

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

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

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

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

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

Monday, April 9, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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