Princess Health and Official praises needle exchanges and medication-assisted treatment for addiction: 'Treatment works. Recovery is possible.' . Princessiccia

Princess Health and Official praises needle exchanges and medication-assisted treatment for addiction: 'Treatment works. Recovery is possible.' . Princessiccia

addiction drug abuse drug treatment health care access heroin needle exchanges pregnancy public health

Gusty 16:12 Add Comment

Scott Hesseltine

Scott Hesseltine, the new vice-president of addiction services at Louisville's Seven Counties Services, talked on Kentucky Educational Television about needle exchanges and a new model of addiction treatment that combines medication assisted treatment with an abstinence-based model of care.

"We are in the midst of a tragic public-health crisis and it's claiming the lives of our citizens at astronomical rates," he said, noting that more than 1,000 people die from drug overdoses in Kentucky each year and that the state has the highest rate of hepatitis C in the nation.

Seven Counties Services provides behavioral-health services, primarily for people on Medicaid, in Jefferson County and six neighboring counties: Henry, Oldham, Trimble, Spencer, Shelby and Bullitt.

The interview on "Connections with Renee Shaw" was part of KET's "Inside Opioid Addiction" initiative, which is funded in part by a grant from the Foundation for a Healthy Kentucky. It aired in June.

Hesseltine, who came to Seven Counties Services from the Hazelden Betty Ford Foundation, a nationally recognized drug and alcohol treatment center, commended Kentucky's "forward thinking" in passing an anti-heroin bill last year.

Among other things, the bill allows needle exchanges to decrease the spread of infectious diseases, like hepatitis C and HIV, that are commonly spread by drug users sharing needles. They require both local approval and funding and have met with some resistance because many think they condone or perpetuate drug use.

Asked about that, Hesseltine said research shows that needle exchanges do what they are meant to do -- reduce the incidence of infectious disease among intravenous drug users.

He noted that Justice Secretary John Tilley, who was instrumental in passing the heroin bill as a state representative, said at a recent community forum in Corbin that research found that addicts who are involved in needle exchange programs are five times more likely to enter treatment.

"And we know treatment works and recovery is possible, so any avenue to slow the spread of disease and to help more people find the solution in recovery is a positive thing," he said.

Another point of contention among some lawmakers is that some of the state's needle-exchange programs don't adhere to a needle-for-needle exchange, which they say was the intent of the law,but instead provide as many needles as the addict needs for a week.

Hesseltine said the needs-based model decreases needle sharing and thus disease, so "Needs-based is more appropriate; it is more evidence based."

Hesseltine told Shaw that while working at Hazelden, he was part of an initiative that completely "altered the way we provided care." The new program, called COR-12, combines medication-assisted treatment with the 12-step abstinence model, which had been the only accepted recovery treatment program at Hazelden.

Hesseltine brought the new model with him to Seven Counties Services and said he likes to call it "medicated assisted recovery." He said "It has to be done appropriately so we are helping to stabilize someone from their biological symptoms of addiction so they can then engage in the recovery process."

Hesseltine told Shaw that addiction isn't curable, but is treatable.

"I would say it is a chronic disease that can be put into remission with structure, support, accountability and behavioral interventions," he said. "Curable? No, but like diabetes -- not curable, but certainly manageable."

Shaw asked if any addict is beyond reach. "Only someone who is not alive," Hesseltine replied. "Treatment works. Recovery is possible." He said that is why access to naloxone, the overdose-reversal drug branded as Narcan, is so important.

Asked what policy changes he would like to see, Hesseltine listed increased funding for drug treatment, "high level" models of care that shift addiction services to local communities, and repeal of the Medicaid rule that doesn't allow any reimbursement for mental-health and substance-use-disorder residential treatment facilities with more than 16 beds.

With treatment, Hesseltine said, "People can go from a pitiful and incomprehensible demoralization, a state where they have no hope to one of having hope, to being a productive member of society and to really regaining a place where they feel good about themselves and they are leading a life full of joy and freedom."

Princess Health and Leading tobacco foe is fighting Big Tobacco again, this time because the industry has taken over the electronic cigarette trade. Princessiccia

Princess Health and Leading tobacco foe is fighting Big Tobacco again, this time because the industry has taken over the electronic cigarette trade. Princessiccia

addiction electronic cigarettes research smoking tobacco

Gusty 19:02 Add Comment

By Melissa Patrick

Kentucky Health News

One of the nation's top anti-tobacco advocates told his Kentucky allies last week that the debate about electronic cigarettes makes him feel like he's "gotten in a DeLorean and gone back to the '70s," like they did in the movie "Back to the Future."

Stanton Glantz
photo: ucsf.edu

"Is it bad? Is it polluting? Does it have second-hand smoke? Blah, blah, blah, freedom, blah, blah, blah," Stanton Glantz ranted at the Kentucky Center for Smoke-Free Policy's spring conference April 28, lamenting how Big Tobacco has taken over the e-cigarette business and is using old marketing strategies to get kids to use e-cigs.

"The business is being taken over by the big multi-national tobacco companies and they are the ones who are doing all the advertising," Glantz said. "They are the ones who are doing all the marketing to kids; they are the reason the use among kids is exploding."

Glantz, a University of California-San Francisco professor and tobacco-control researcher, acknowledged that e-cigs are less toxic than cigarettes. But he said that doesn't make them safe, and most e-cig users also use tobacco, so they are not reducing harm. He also blasted the claims that e-cigarettes help people quit smoking, saying the claims are anecdotal.

However, the Royal College of Physicians, a major British medical organization, just published a report that says those who use e-cigarettes to quit smoking have a 50 percent better chance of success than if using no aids or using nicotine patches without counseling, Sabrina Tavernise reports for The New York Times.

Glantz disagreed with the report. He cited a meta-analysis he published a few months ago that found e-cigs don't help people quit smoking.

"On average, smokers who use e-cigarettes are 30 percent less likely to quit smoking than smokers who don't use e-cigarettes,"he said. "So, they are extending the tobacco epidemic."

Glantz said that the British researchers predicted what they think is going to happen, but U.S. data shows what is happening. "They have collectively lost their minds," he said.

Youth and e-cigarettes

Glantz said that he would normally not encourage advocates to focus their efforts on children, because "kids do what adults do," but he said that isn't so with e-cigs, which are being directly marketed toward them with candy flavored products.

"I think e-cigarettes are different. E-cigarettes are different because this is an epidemic that is growing from the bottom up," he said. "And the data on kids is like very scary. Non-smoking kids who use e-cigarettes, if you come back a year later, they are three times more likely to be smoking cigarettes than the non-smoking kids who aren't using e-cigarettes."

Glantz wrapped up saying, "So, the bottom line on e-cigarettes is they are likely to prolong the tobacco epidemic because they are restoring social acceptability of tobacco use. They are depressing quitting among smokers and they are attracting kids to nicotine, a lot of whom are going to convert to cigarettes."

Glantz is best known for leading the movement to call out the deceptive marketing messages of cigarette manufacturers and expose the dangers of tobacco during the 1990s, with the help of documents showing that tobacco executives were aware of the dangers of their products while marketing them aggressively toward young adults and teens.

Glantz's current research focuses on the health risks associated with secondhand smoke and the correlation between high smoking rates and heart attack deaths. He also works to change policy that would mandate an "R" rating for any movie with smoking in it.

Princess Health and Women in small-town America aren't living as long as before; alcohol, drugs, food, housing, jobs, education, pollution to blame. Princessiccia

Princess Health and Women in small-town America aren't living as long as before; alcohol, drugs, food, housing, jobs, education, pollution to blame. Princessiccia

addiction drug abuse drug treatment drug use drugs federal spending life expectancy women women's health

Gusty 08:02 Add Comment

By Trudy Lieberman
Rural Health News Service

Those of us who grew up in small rural communities in the 1950s and '60s expected to have longer life spans than our parents.

The trends were in our favor. White women born in 1900 could expect to live, on average, just shy of 49 years; white men 46.6 years. Those were our grandparents and our neighbors. By 1950, life expectancy had climbed to 72 years for white women born that year and 66.5 for white men. By 2000, life expectancy was still increasing, with female babies expected to live to nearly 80 and males to almost 75.

America was on the rise, jobs were plentiful, antibiotics kept us from dying of strep throat, and polio vaccine kept us out of the iron lung. We thought things would only keep getting better. So I was dismayed to read a story in The Washington Post in April that blew holes in those childhood expectations.

The Post found �white women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s, and 50s in a slow-motion crisis driven by decaying health in small town-America.�

That �small town America� was where I grew up. I contrasted the Post�s findings to the claims made by all those politicians who have told us we have the best health care in the world and who point to gobs of money lavished on the National Institutes of Health to find new cures and to hospitals promoting their latest imaging machines.

The Post found that since 2000, the health of all white women has declined, but the trend is most pronounced in rural areas. In 2000, for every 100,000 women in their late 40s living in rural areas, 228 died. Today it�s 296.

If the U.S. really has the best healthcare, why are women dying in their prime, reversing the gains we�ve made since I was a kid? After all, mortality rates are a key measure of the health of a nation�s population.

Post reporters found, however, that those dismal stats probably have less to do with health care � which we like to define today as the latest and greatest technology and insurance coverage albeit with high deductibles � and more to do with what health experts call �the social determinants of health,� such basics as food, housing, employment, air quality, and education.

Landmark studies examining the health of British civil servants who all had access to health insurance under Britain�s National Health Service have found over the years that those at the lowest job levels had worse health outcomes. Some of those outcomes were related to things like work climate and social influences outside work like stress and job uncertainty.

In its analysis, the Post found that the benefits of health interventions that increase longevity, things like taking drugs to lower cholesterol and the risk of heart disease, are being overwhelmed by increased opioid use, heavy drinking, smoking and obesity.

Some researchers have speculated that such destructive health behaviors may stem from people�s struggles to find jobs in small communities and the �dashed expectations� hypothesis. White people today are more pessimistic about their opportunities to advance in life than their parents and grandparents were. They are also more pessimistic than their black and Hispanic contemporaries.

A 42-year-old Bakersfield, California, woman who was addicted to painkillers for a decade explained it this way: �This can be a very stifling place. It�s culturally barren,� she said. There is no place where children can go and see what it�s like to be somewhere else, to be someone else. At first, the drugs are an escape from your problems, from this place, and then you�re trapped,� she told Post reporters.

I recently heard U.S. Surgeon General Dr. Vivek Murthy talk about his upcoming report on substance use. About 2.2 million people need help, he said, but only about one million are actually getting it. Murthy wants his report to have consequences as far reaching as the 1964 surgeon general�s report linking tobacco use to lung cancer. In 1964, Murthy noted, 42 percent of Americans smoked; today fewer than 17 percent do.

The Post story concludes that the lethal habits responsible for increasing mortality rates are cresting in small cities where the biggest manufacturer has moved overseas or in families broken by divorce or substance abuse or in the mind and body of someone doing poorly and just barely hanging on.

The Surgeon General has taken on an enormous task, but his efforts just might help the nation move its life expectancy trends back in the right direction.

What do you think is causing poor health in your community? Write to Trudy at trudy.lieberman@gmail.com.

Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed by the Nebraska Press Association.

Princess Health and Trying to stop overdose epidemic, CDC tells docs to limit most opioid prescriptions to 3-7 days, use low doses and warn patients. Princessiccia

Princess Health and Trying to stop overdose epidemic, CDC tells docs to limit most opioid prescriptions to 3-7 days, use low doses and warn patients. Princessiccia

addiction drugs federal government health insurance Medicaid Medicare narcotics pain pain management prescription drug abuse prescription drugs

Gusty 20:35 Add Comment

Graphic from CDC guideline brochure

Kentucky Health News

Doctors who prescribe highly addictive painkillers for chronic pain should stop and be much more careful to thwart "an epidemic of prescription opioid overdoses" that is "doctor-driven," the federal Centers for Disease Control and Prevention said Tuesday, March 15.

"This epidemic is devastating American lives, families, and communities," the CDC said. "The amount of opioids prescribed and sold in the U.S. quadrupled since 1999, but the overall amount of pain reported by Americans hasn�t changed."

Kentucky ranks very high in use of opioids and overdoses from them, and Louisville reported a big increase in overdoses this month, Insider Louisville reports.

The agency said doctors should limit the length of opioid prescriptions to three to seven days, use "the lowest possible effective dosage," monitor patients closely, and clearly tell them the risks of addiction.

It said most long-term use of opioids should be limited to cancer, palliative and end-of-life treatment, and that most chronic pain could be treated with non-prescription medications, physical therapy, exercise and/or cognitive behavioral therapy.

The guidelines are not binding on doctors, but Dr. Thomas Frieden, the CDC director, "said state agencies, private insurers and other groups might look to the recommendations in setting their own rules," the Los Angeles Times reported.

However, Modern Healthcare reported that the guidelines are unlikely to change physicians' practices. "One current hurdle to curbing the number of prescriptions is that it's much easier for a busy clinician to prescribe a 30-day supply of oxycodone or Percocet to treat a patient's chronic pain than it is to convince him or her to do physical therapy," Steven Ross Johnson writes. "The time constraints affecting physicians' practice has never been more acutely felt than in this era of health-care reform that emphasizes quality and value-based payment."

Money could be a key in making the guidelines effective. Sabrina Tavernise of The New York Times writes, "Some observers said doctors, fearing lawsuits, would reflexively follow them, and insurance companies could begin to us them to determine reimbursement." The federal Centers for Medicare and Medicaid Services could also play a role.

Johnson notes that physicians are trained to "reserve opioids for severe forms of pain . . . but in the 1990s, some specialists argued that doctors were under-treating common forms of pain that could benefit from opioids, such as backaches and joint pain. The message was amplified by multi-million-dollar promotional campaigns for new, long-acting drugs like OxyContin, which was promoted as less addictive."

Purdue Pharma, maker of OxyContin, agreed to pay $600 million in penalties to settle federal charges that it over-promoted the drug to doctors, prompting the epidemic, especially in Central Appalachia.

"When reports of painkiller abuse surfaced, many in the medical field blamed recreational abusers. In recent years, however, the focus has shifted to the role of doctors," Harriet Ryan and Soumya Karlamangla report for the Times, noting that a 2012 analysis "of 3,733 fatalities found that drugs prescribed by physicians to patients caused or contributed to nearly half the deaths."

Doctors, insurers, drug companies and government agencies "all share some of the blame, and they all must be part of a solution that will probably cost everyone money," Caitlin Owens writes for Morning Consult, which also notes prescribers' complaints and CDC's responses.

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

addiction courts heroin hospital-a

Gusty 20:15 Add Comment

Jails, treatment facilities, drug courts and hospitals are struggling to provide the necessary help as more Kentuckians become addicted to heroin, Chris Kenning writes for The Courier-Journal: "In a state that already had a shortage of drug-treatment options, the heroin problem is badly outstripping Kentucky's ability treat it." A Kentucky Health Issues Poll found that 9 percent of Kentuckians and 15 percent aged 18 to 29 reported awareness of a family member of friend struggling with heroin.

"We're just bursting at the seams," said Karyn Hascal, who is head of The Healing Place, a Louisville drug-treatment center. "I've been around 35 years, and I've never seen anything hit this fast and this hard." Though heroin users were few and far between several years ago, now they take up 90 percent of The Healing Place's detox beds.

The Louisville jail deals with 30 to 90 inmates every day. It has hired four around-the-clock detox nurses, started new detox dorm programs and added training officers since 2012, and "increased our inmate health-care budget by hundreds of thousands of dollars," said Metro Corrections director Mark Bolton.

Heroin may be "the most addicting drug there is," said Dr. Christopher Stewart, an addiction psychiatrist and medical director at the Jefferson Alcohol and Drug Abuse Center. Heroin crosses the blood-brain barrier and becomes morphine, "binding to opioid receptors in the brain and sparking an intense rush of pleasure and euphoria�one that's far more sharp and immediate than opiate pills," Kenning writes. People become immune to its effects and need to take more of it, and withdrawal symptoms include pain, vomiting, insomnia, spasms and cravings.

While longer-term treatment for severe addictions often includes patient resident programs including counseling, Kentucky lacks this kind of care. "There are not enough open-entry detox and treatment beds in this community�I'm talking non-insurance beds," Bolton said. Dr. Eric Fulcher, an emergency room doctor said that providing emergency treatment for heroin addicts has become "the new normal" at Sts. Mary and Elizabeth in the South End. "We're so used to it, we're almost numb to it."

Although the former director of the Office of National Drug Control Policy, Gil Kerlikowske, recommended the increased availability of naloxone, used to counteract heroin overdoses, the General Assembly didn't pass a bill "that in part would have made naloxone more widely available, along with other heroin-related measures," Kenning writes.

Jefferson District Judge Stephanie Pearce Burke said that "heroin use is present in more than three-quarters of her cases." Something has to be done. "People still have the idea that it's a drug from the '60s and homeless people in the park," she said. "But the face of heroin has changed. It's suburban teens and middle-class housewives, too." (Read more)

Princess Health and Princess Health andStates and their congressmen battling new painkiller that is easier to crush and inject.Princessiccia

Princess Health and Princess Health andStates and their congressmen battling new painkiller that is easier to crush and inject.Princessiccia

addiction drug abuse drugs

Gusty 20:49 Add Comment

Some states are restricting the use of the new painkiller Zohydro, "setting up a showdown with the federal government over who gets to decide the best way to protect public health," Michael Ollove reports for Stateline.

Rogers (Herald-Leader photo)

Though millions of chronic pain sufferers could benefit from the drug, some officials worry that abusers will crush and inject it for a big high, will significantly worsen the painkiller abuse crisis they have been battling. Combating prescription drug abuse has been a focus in Kentucky for the past few years. U.S. Reps. Hal Rogers of Somerset and Stephen Lynch of Massachusetts have introduced a bill to withdraw the Food and Drug Administration's approval, done though an advisory board voted 11-2 against it.

A federal judge told Massachusetts officials that they cannot ban a drug that the FDA has declared safe and effective, but Gov. Deval Patrick is restricting its use. Vermont Gov. Peter Shumlin has taken similar measures, and the Ohio legislature is debating similar action. Twenty-nine state attorneys general, including Kentucky's Jack Conway, have requested that the FDA rethink its approval of Zohydro.

"We're in the context of a very serious epidemic of opioid drug addictions and opioid deaths, and that's a public health crisis that has been growing over the last decade and half," said Michael Carome, director of the Health Research Group at the consumer organization Public Citizen. "The last thing we needed was another extended release opioid for treating chronic pain."

According to Trust for America's Health's 2013 report, "6.1 million Americans abuse or misuse prescription drugs," and "Overdose deaths involving prescription painkillers have quadrupled since 1999, and now outnumber those from heroin and cocaine combined, Ollove reports. Zohydro is an opioid, and opioids are not only easily abused but are also unfortunately gateway drugs, influencing people to use heroin, which isn't as expensive. One advantage to Zohydro is that it is a single-ingredient, long-acting product, unlike other painkillers that were combined with acetaminophen, which can be injurious to the liver.

Opponents are frustrated that the FDA not only approved the drug but also did not force the manufacturer, Zogenix, to create a version that isn't so easy to abuse. The company has said it is making such a version. "In the meantime, it said it has implemented other safeguards, such as compensating sales representatives for educating doctors, pharmacists and patients on the risks and benefits of extended-release opioids," Ollove writes.

Sherry Green, chief operating officer of The National Alliance for Model State Drug Laws, agreed withZohydro maker Zogenix "that taking action against selective prescription drugs is the wrong approach," Ollove reports. Green said, "When we focus almost solely on an individual drug, we tend not to put as much attention on the underlying problem, which is the abuse and addiction. Obstructing illicit routes to one medication only creates pathways to another one." (Read more)

Princess Health and Princess Health andGeneral Assembly's failure to pass heroin bill incites wrath, calls for local action and a special session.Princessiccia

Princess Health and Princess Health andGeneral Assembly's failure to pass heroin bill incites wrath, calls for local action and a special session.Princessiccia

addiction drug abuse General Assembly heroin HIV legislature

Gusty 17:54 Add Comment

In the final hours of the 2014 legislative session, the House failed to pass Senate Bill 5, which would have helped combat heroin abuse. Some heroin-recovery advocates and community leaders are outraged, and now people are searching for local solutions to the problem while waiting for the General Assembly to act.

Senate Bill 5 would have allowed prosecutors to charge drug traffickers with homicide if someone died from an overdose of drugs sold by a trafficker, and allocated savings from a 2011 prison reform to fund drug-treatment programs. It would have permitted first responders and addicts' family members to give naloxone, a life-saving drug, to someone who overdosed. Amendments to the bill would have begun an program for addicts to exchange used needles for new ones, decreasing the prevalence of hepatitis C and HIV, and making Zohydro, a powerful painkiller, illegal�until it is changed into a tamper-resistant variety, Scott Wartman and Terry DeMio write for The Kentucky Enquirer.

"During a meeting in Campbell County Thursday night, many who are involved in heroin treatments predicted that a delay in passing the bill will result in more deaths and heartache throughout the commonwealth�and specifically in Northern Kentucky, which has been the most affected area by the deadly drug," Don Weber reports for cn|2's "Pure Politics." 

Charlotte Wethington, who works as a recovery advocate at the residential treatment center the Grateful Life Center, lost her son Chad 12 years ago because of an overdose. "I've been fighting this battle for well over a decade, and it is long overdue, past overdue, that we address the heroin epidemic," Wethington said, Weber writes. Dr. Mike Kalfas, a Northern Kentucky physician who treats heroin addicts, says Senate Bill 5 could have stopped what he says might be HIV or Hepatitis C epidemics in the near future. "Everywhere else there's been an IV drug problem, over time, the drug problem builds, then the Hepatitis C problem builds, and not far behind them is HIV," he said.

Because the bill didn't pass, communities are looking for local solutions, even if resources are limited. Dr. Bonnie Hedrick of the Northern Kentucky Agency for Drug Abuse reported that her organization is not only working on needle cleanup projects but also encouraging local doctors to prescribe the antidote to those who are addicted, Rae Hodge of The Associated Press reports. "Northern Kentucky Drug Strike Force director Bill Mark said that unless Gov. Steve Beshear calls the legislature into a special session to consider the bill, his organization has few tools to fight the state's growing heroin problem."

Beshear hasn't decided whether to call a session. "He argued that every session produces worthy bills that die, and 'it's too early to determine if a special session on any topic is prudent or needed,'" Beshear said, Mike Wynn writes for The Courier-Journal. Republican Senate President Robert Stivers has urged Beshear to call a session. He said, "This isn't political. This is about real people; this is about real problems; this is about real people losing their lives."

Princess Health and Princess Health andHighly addictive, crushable pain killer to be released this month; political leaders beg FDA to reconsider its decision .Princessiccia

Princess Health and Princess Health andHighly addictive, crushable pain killer to be released this month; political leaders beg FDA to reconsider its decision .Princessiccia

addiction food and drug administration prescription drug abuse prescription drugs

Gusty 09:00 Add Comment

A new narcotic pain pill is set to be released to the market this month, and critics are begging the Food and Drug Administration to reverse its decision, fearing its addictive qualities and overdose potential, Laura Ungar reports for The Courier-Journal.

Zohydro ER is an extended-release hydrocodone medication made by Zogenix. It is a highly addictive drug only meant for patients with pain severe enough to require daily, round-the-clock, long-term treatment, for whom other treatments are inadequate.

"It�s a capsule of pure hydrocodone so powerful that one accidental dose can kill," Ungar writes. Doctors, lawmakers, drug-control officials and others are voicing their concerns that Zohydro ER will bring a new wave of prescription drug abuse to Kentucky just as Kentucky has been making "great strides" against this already existing problem.

Zohydro ER, unlike recent formulations of the popular painkillers OxyContin and Opana, is not crush-resistant, making it easier for abuse by crushing and then snorting or injecting it, Ungar reports.

Kentucky ranks third in the nation for overdose deaths, with more than 1,000 Kentuckians dying each year from prescription drug overdoses. The number has leveled off following passage of laws that target pill-pushing clinics and doctors, and put stricter regulations on painkillers.

�We could see the OxyContin days come back, just in a new form,� Dan Smoot, president and chief executive officer of the Eastern Kentucky anti-drug organization Operation UNITE, told Ungar.He was referring to the drug that first sparked Appalachia�s prescription abuse problem in the late 1990s.

The FDA approved Zohydro ER last fall, even though its own scientific advisory panel cited concerns about misuse and abuse and voted 11-2 against approving it. It�s set to hit the market early this month, Ungar reports. Last week a coalition of more than 40 health, consumer and other organizations urged the FDA to revoke its approval.

Attorney General Jack Conway was among 28 attorneys general who sent the FDA a letter asking it to reconsider, noting that it is reportedly "five to 10 times more potent than traditional hydrocodone products, and has no abuse-deterrent properties."

�We do not want to see the great strides we have made in Kentucky combating prescription drug abuse reversed,� Conway said in a statement after signing the letter. �For decades, we have fought the disastrous effects of the illegal marketing of the drug OxyContin. Zohydro ER has the potential to exacerbate the prescription-pill epidemic. ... The FDA�s decision to approve the drug doesn't make sense.�

U.S. Rep. Hal Rogers, R-5th District, and Senate Republican Leader Mitch McConnell, as well as two other senators, have expressed their disapproval, but the FDA says the drug meets its safety requirements and the benefits outweigh the risks for patients who qualify for the drug, Ungar reports.

Zogenix officials told Ungar they are committed to going �above and beyond FDA requirements� to make sure the drug is used appropriately, will monitor for misuse, and will allow an outside group to monitor and analyze their data. They said they are also working on an abuse-resistant pill.

They also pointed out that Zohydro ER will be regulated as a Schedule II controlled substance, which means it can only be dispensed through a physician�s written prescription, with no refills.

�Opioids are important pain-relieving medications that can provide significant benefits for patients when used properly for their approved indications,� Zogenix wrote Ungar.

Another benefit cited by Zogenix officials is that unlike many other hydrocodone painkillers, Zohydro ER does not contain acetaminophen, which can cause liver failure when used over a long period. They said more than half of liver transplants are caused by acetaminophen overdoses from overusing these sorts of combination drugs.

Princess Health and Big papers' Page 1 stories spotlight recovery center for pill addicts, lack of state program for problem gamblers.Princessiccia

Princess Health and Big papers' Page 1 stories spotlight recovery center for pill addicts, lack of state program for problem gamblers.Princessiccia

addiction drug abuse drugs gambling recovery

Gusty 13:01 Add Comment

Gripping stories from recovering addicts, on the front pages of Kentucky's two largest newspapers this morning, highlight Kentuckians' fights against all types of addiction, from gambling to drugs.

Hope of recovery emerges from Laura Ungar's story in The Courier-Journal that focuses on the Isaiah House recovery center in Willisburg. A gymnasium at the site has been transformed into a factory of sorts, where a pill addict who has been clean three weeks polishes car parts, while a morphine addict with 103 days� sobriety hammers nails into wood to make pallets, Ungar reports.

Work is an essential part of recovery at the Isaiah House, giving structure to chaotic lives, teaching job skills and building confidence. �It gives them a sense of purpose, of accomplishment,� Executive Director Mark LaPalme told Ungar. �They get their dignity back � that�s what work does.�

LaPalme, a Connecticut native and recovering cocaine addict, said he started Isaiah House in his basement in 1999, after a spiritual experience moved him to set aside seven bedrooms for other addicts. Today, the house helps to rebuild the lives of drug and alcohol addicts, while promoting worth ethic and responsibility throughout the recovery process (Read more).

Jack Brammer of the Lexington Herald-Leader writes about Kentucky's lack of a state program to treat problem gamblers. It is one of 13 states without such a program.

Billy Stephens, 66, Hawesville Mayor Rita Stephens' husband, said he lived a "a life of lies" with his gambling addiction, but with professional treatment, has not gambled since 2010. When he finally sought treatment, he could find no affordable treatment in Kentucky. The family had to borrow money to pay for his $6,000 treatment in a 36-day program in Louisiana, which is free to residents of the Bayou State.

"My addiction almost destroyed me," he told Brammer. "My insurance in Kentucky would have helped with my treatment if it were alcohol. But it was gambling." (Read more)

Princess Health and FDA likely to make hydrocodone painkillers harder to prescribe.Princessiccia

Princess Health and FDA likely to make hydrocodone painkillers harder to prescribe.Princessiccia

addiction doctor shopping drugs pain prescription drug abuse prescription drugs

Gusty 10:34 1 Comment

Prescription painkillers containing hydrocodone should be placed in a more restrictive federal category, a Food and Drug Administration advisory panel of experts voted on Friday. The changes would be an effort to stem the tide of prescription painkiller abuse and addiction in the U.S., much of it in rural areas, beginning in Central Appalachia. Painkillers containing hydrocodone are the most widely prescribed drugs in the country.

Sabrina Tavernise of The New York Times reports the FDA is likely to adopt the panel's recommendations, which include limiting access to hydrocodone drugs such as Vicodin by making them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted. Only a hanwritten prescription from a doctor would be allowed, and pharmacists would be required to keep the drugs in special vaults.

Many said these changes would be a key step in reducing painkiller addiction. However, dissenters in the vote were concerned that this move wouldn't make a difference. Oxycodone, the main ingredient in the highly-abused painkiller OxyContin, has been classified in a restrictive category since it was first introduced on the market but it is still widely abused, dissenters said. They also said the change could create unfair obstacles for legitimate patients. (Read more)

Princess Health and Coventry changes course, will pay for addiction-treatment drug.Princessiccia

Princess Health and Coventry changes course, will pay for addiction-treatment drug.Princessiccia

addiction drug abuse drugs managed care Medicaid state government

Gusty 18:55 Add Comment

Reversing its decision, likely after it was pressured to do so, a Medicaid managed-care organization will continue to pay for a drug used to treat drug addiction.

Coventry Cares said it "decided to change course after talking to representatives of a chain of addition treatment clinics that threatened last week to sue Coventry," reports Beth Musgrave for the Lexington Herald-Leader.

Last week, the Cabinet for Health and Family Services sent Coventry a letter expressing its displeasure about the MCO's move, saying it would be a contractual violation. The drug in question is Suboxone, an expensive treatment option for addicts dependent on taking opioids such as Oxycontin and Vicodin. Coventry had said it was aligning its coverage in keeping with Medicaid policy, moving to only cover the full price of the drug for pregnant or recently pregnant women and youth under 21.

After the MCO discussed the issue with SelfRefind, the chain of addiction treatment clinics in question, "Coventry understands their concerns," said Coventry spokesman Eyles. "As a result, we will continue covering Suboxone and similar medicines for all Coventry members while we work through the cabinet's process to determine whether these drugs should be covered for certain categories of Medicaid recipients or everyone." (Read more)

Princess Health and Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction.Princessiccia

Princess Health and Medicaid managed-care firm Coventry plans to stop paying for expensive drug that curtails addiction.Princessiccia

addiction drug abuse drugs managed care Medicaid state government

Gusty 11:29 Add Comment

Coventry Cares, one of the four firms that manage patient care for the state Medicaid program, has once again hit the headlines, this time for its plans to stop paying for medicine that helps addicts keep their opioid addiction at bay. State officials quickly condemned the move Thursday and called it a contract violation, reports Beth Musgrave of the Lexington Herald-Leader.

Coventry decided to stop paying for buprenorphine, more commonly known as Suboxone, which helps curtain cravings for drugs such as Oxycontin and Vicodin. A 30-day supply of the drug can cost more than $450, Musgrave reports.

"They will be at risk for relapsing and going back to using illegal opioids," Dr. Michelle Lofwall, an addiction specialist and assistant professor at the University of Kentucky, told Musgrave. "Whenever you are using illegal opioids, there is a risk of overdose and death."

Coventry said it will no longer offer the coverage because only pregnant women, women who recently gave birth and those under the age of 21 are eligible for addiction treatment in Kentucky's Medicaid program. "What we've done is align our coverage with the cabinet's Medicaid policy," said Matt Eyles, a Coventry spokesman.

However, the state Cabinet for Health and Family Services said the decision violates the contract and "cannot take this unilateral action without the cabinet's approval," said Jill Midkiff, a cabinet spokeswoman. 

A company that operates addiction treatment centers across the state was planning to file suit over the move Friday, but, after learning of the cabinet's reaction, "We are going to give them the chance to work this out," Anna Whites, an attorney who represents SelfRefind.

Coventry already caused controversy this week when it informed Baptist Health System wants to renegotiate its contract. The move comes just a week after Coventry and Appalachian Regional Healthcare came to a temporary agreement after Coventry threatened to terminate its contract and ARH sued Coventry. The company has also told King's Daughters Medical Center in Ashland it will terminate its contract after May 26. (Read more)

Princess Health and Need for painkillers and social support, shortage of treatment programs, feeds prescription drug abuse in Appalachian Ky..Princessiccia

Princess Health and Need for painkillers and social support, shortage of treatment programs, feeds prescription drug abuse in Appalachian Ky..Princessiccia

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Gusty 09:04 Add Comment

By Ivy Brashear
Kentucky Health News

Taking opioids is still the best way to treat patients with pain, but the drugs are addictive because they do more than just alleviate physical suffering � they cause patients to feel good too. That's causing big problems in Kentucky, the state with the highest rate of opioid use and overdose.

In Perry County, for example, prescription medicines are the drugs of choice, second only to marijuana, and users may get more of them from relatives than from doctors. And their drug use appears to be part of a social support system.

Those were the findings of three separate studies presented at the second annual Appalachian Health Summit in Lexington last week.

Prescription-drug abuse is "an epidemic" that "seems to have started in rural Appalachia," Jennifer Havens, an associate professor in the University of Kentucky Department of Behavioral Science, said in presenting a study showing how disease spreads through the region.

Havens� study of Hazard and Perry County found that prescription drug abuse in the county is second to marijuana use, and that painkiller abuse among high school seniors is at the same rate as in adults.

Though it�s not clear why prescription drug abuse is so rampant in the region, Havens speculated that lack of availability of other �hard� drugs, like heroin and cocaine, has led Appalachian drug users to turn to prescription medicine to get high. There are few drug-treatment options for users in the region, and many hospitals aren�t �financially viable� to care for drug abusers, she said.

An earlier study in which Havens was involved revealed that rural adults use more �alternate� methods to take drugs, including snorting and injecting. The study compared drug users in Perry County to those in Louisville and found that more than 40 percent of adults in the Hazard area were injecting prescription drugs to get high, and youth there were 25 percent more likely than those in Louisville to abuse such drugs.

The study found high rates of sharing drug-taking instruments, which increases risk for diseases such as hepatitis and HIV, Havens said. Almost 90 percent of participants said they shared snorting straws, and almost 1 in 3 said they shared syringes. No cases of HIV were found among the participants, but almost 43.7 percent of the 500 interviewed had hepatitis-C, and 11.5 percent had herpes-2.

Eighty percent were lifetime users, and about half first abused Oxycontin through injection. Havens said 28 percent of users had overdosed, and 58 percent had witnessed an overdose.

The study also found that a person�s likelihood of continuing drug use correlated with higher levels of social support, which Havens said contradicts long-held assumptions that drug users continue to abuse prescription pills because of low social support.

�Most people in the study depended on people also using drugs for social support,� Havens said. �As you can imagine, that�s not a good idea.�

No good alternative to prescribing painkillers

Despite widespread opioid abuse in Appalachia, such drugs are �still the best pain therapy,� UK physiology professor Karin Westlund High reported.

The purpose of her study was to determine what effect a high-fat and alcohol diet would have on �visceral pain� in the pancreas, and then what effect opioid gene therapy would have on the organ.

There are clusters of Appalachian counties at high risk for pancreatitis, which can lead to pancreatic cancer. Severe abdominal pain is associated with both, and morphine is typically used to treat it. However, High said, patients usually develop a tolerance to the drug over time.

She and other researchers used rats to test an opioid gene therapy involving herpes simplex-1, which 90 percent of Americans already have, to see if it would reduce pancreatitis pain without building tolerance in the rats. After 10 weeks of treatment, there was no tolerance present and the therapy seemed to be reversing damaged sections of the pancreas caused by the disease.

While opioids are effective in alleviating pain, "There are lots of different kinds of pain, but most opioids act as if they treat the same pain,� said Michelle Lofwall, a UK psychiatry and behavioral science assistant professor. Lofwall set out to discover how pain affects prescription drug abuse, since that is the main reason such drugs are prescribed or first used.

Her study participants, who were all drug users, placed one arm in a cooler of ice to elicit pain, and then were asked about pain levels. The test was repeated after a dose of painkiller.  Researchers were attempting to give the drug to treat patients� pain only, and not to have the patient feel a high when the drug was in their system, but that failed.

�Unfortunately, in my patients I wanted to say, �Yes, let�s treat your pain and you won�t feel any good effects�,� Lofwall said. �I wasn�t able to say that to them.� She said they are now trying to help doctors better prescribe pain medication so that habits aren�t formed.

One of the biggest habit-forming painkillers is Oxycontin, which was introduced in 1996 but wasn�t abused on a large scale until doctors had to start documenting pain in 1999, Lofwall said. Sales of, treatment for, and death from prescription drug abuse have increased since then. She noted that Kentucky has the highest rates of opioid use and overdose.

The makers of Oxycontin have reformulated the drug to make it harder to crush, mix with water and snort, but a new drug has risen to take its place: Opana. Lofwall said researchers have been trying to study Opana use, but can�t get a study supply because it is in such high demand. She said she has seen more of a rise in heroin use by her patients because even heroin is easier to get than Opana.

Though legislators are grappling to curb the proliferation of "pill mills" in the state, Lofwall said "doctor shopping" may not be the problem it's been billed to be. According to the National Household Survey on Drug Use and Health, 56 percent of users get their supply from a relative, of whom 85 percent have a prescription from one doctor. The drug abuser may get the drug from the relative as a gift, by paying for it or by stealing it.

Asked about the Kentucky All Schedule Prescription Electronic Reporting system, which allows doctors to search a database for �doctor shoppers� before prescribing pain pills, Lofwall said KASPER is limited because it only covers Kentucky, but �I think the state�s ready to make it better.�

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