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."