Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Appalachia doctors drug abuse drugs General Assembly legislature narcotics pain pain clinics physicians prescription drug abuse prescription drugs state government

Gusty 12:08 Add Comment

Kentucky is the only truly Appalachian state to have put a brake on fatal drug overdoses, report Rich Lord and Adam Smeltz of the Pittsburgh Post-Gazette as part of a series in the about the deadly epidemic of prescription painkillers in the region.

A chart with the series' story about Kentucky shows that fatal drug overdoses were less numerous in the state in 2013 than in 2012, when the General Assembly cracked down on "pill mills," and that while fatal overdoses rose in 2014, they were still not as numerous as in 2012. Official numbers for 2015 are expected soon, and may rise because of the spread of heroin.

The series also credited a crackdown by the Kentucky Board of Medical Licensure, which "took disciplinary action for prescribing irregularities against 135 of the state�s roughly 10,600 doctors" from 2011 to 2015. "The board also moved against 33 doctors during that time for abusing narcotics themselves."

"Getting tough on doctors works," Lord wrote in the series' main story. The state story reported, "Kentucky�s per-capita opioid consumption -- though still seventh in the nation -- dropped by a steepest-in-Appalachia 12.5 percent from 2012 to 2014, according to IMS Health Inc.," Lord and Smeltz report. "Kentucky is the only state, among the seven studied by the Pittsburgh Post-Gazette, in which fatal overdoses have plateaued. Elsewhere, they have climbed relentlessly."

The story quotes Kerry B. Harvey, U.S. attorney for the eastern half of Kentucky: �In much of Eastern Kentucky, the workforce is engaged in difficult, manual labor,� like mining, farming and logging, �so people would injure themselves and be prescribed these very potent narcotics, because the medical profession changed the way it looked at prescribing these kinds of narcotics for pain.� The drugs dulled the �sense of hopelessness� people had about the area�s economy, �and so for whatever reason, this sort of culture of addiction took hold.�

"Harvey said that as physicians have gone to jail, and others have faced board discipline, the painkiller business model has adapted. . . . Now the doctors take insurance, and bill the insurer or the government not just for the office visit, but for the MRI, urine screen and back brace they use to justify the addictive narcotic." Harvey said, �So instead of a cash business, in many cases now the taxpayers or the insurance companies pay. The result is the same. We end up with our communities flooded with these very potent prescription narcotics.�

Princess Health and Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers.Princessiccia

Princess Health and Kentucky is cracking down on Suboxone, a heroin substitute that has become a big part of the illegal trade in painkillers.Princessiccia

doctor shopping doctors drug abuse drugs health insurance health reform insurance coverage narcotics obamacare pain clinics physicians pill mills state government

Gusty 09:40 Add Comment

A drug that was supposed to help people get off heroin has "created a new cash-for-pills market and a street trade" that state officials are trying to stop, Mary Meehan reports for the Lexington Herald-Leader.

The drug is buprenorphine, the active ingredient in the brand-name drugs Suboxone and Subutex, which became more popular in 2012, when the state cracked down on "pill mills" that were freely handing out prescriptions for painkillers. "A lot of the pill mills morphed into facilities that dispense these prescriptions," Dr. John Langefeld, medical director for the state's Medicaid program, told Meehan.

Also, Meehan writes, the Patient Protection and Affordable Care Act required insurance plans to cover treatment for substance abuse, and "as more Medicaid patients and others got health-insurance coverage, more people obtained prescriptions for buprenorphine, Langefeld said. . . . According to a state report, one user obtained prescriptions from nine doctors."

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Lexington Herald-Leader chart by Chris Ware from state data

Use of the drug in Kentucky "has increased 241 percent since 2012," Meehan reports. "And 80 percent of the prescriptions for it were being written by 20 percent of the state's 470 certified prescribers, said Dr. Allen Brenzel, medical director of the state's Department of Behavioral Health. . . . Since 2011, 10 doctors have been sanctioned by the Kentucky Board of Medical Licensure because of problems prescribing Suboxone."

Suboxone is supposed to be taken in conjunction with therapy and drug testing. "a patient receives a controlled dose of a legal drug as the dose is tapered by a physician for a safe and effective withdrawal," Meehan notes. However, "doctors started to see Suboxone patients on a cash basis, asking for as much as $300 for an office visit that included a prescription for the maximum allowable amount of Suboxone. Patients often received no therapy or drug testing. Some patients were on the maximum dose indefinitely, Brenzel said." Some doctors prescribed the drug with other painkillers, creating an illegal market.

To prevent such abuse by unscrupulous doctors, the medical-licensure board has issued regulations that require "more physician education and the requirement that the drug be prescribed only for medically supervised withdrawal and not be given to pregnant women," Meehan writes. "Patients should also be closely monitored and drug tested. If those rules are not followed, a doctor can face sanctions or restrictions to his medical license."

Suboxone was in the national news recently because the accused killer in the Charleston, S.C., shootings was arrested for illegal possession of it four months ago at a South Carolina shopping mall, the Herald-Leader notes.

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Read more here: http://www.kentucky.com/2015/06/20/3910362_the-drug-that-was-supposed-to.html?rh=1#storylink=cpy

Princess Health and Paducah Sun looks at two local doctors who write many prescriptions for painkillers; such local data are easily available.Princessiccia

Princess Health and Paducah Sun looks at two local doctors who write many prescriptions for painkillers; such local data are easily available.Princessiccia

doctors drug abuse narcotics pain pain clinics pain management physicians pill mills prescription drug abuse

Gusty 11:52 Add Comment

The Paducah Sun has used some easily available information about two local doctors to shine a local light on their heavy prescribing of opioids.

The story by Laurel Black begins, "As narcotic painkiller abuse has drawn more public attention, two Paducah physicians � who have been ranked high among prescribers of such drugs � have found themselves defending their practices."

The story cites The Courier-Journal's analysis of 2012 Medicare data that showed Dr. Yogesh Malla of Paducah was "the No. 3 prescriber of narcotic painkillers in the commonwealth. A USA Today article listed Dr. Riley Love, also of Paducah, as 20th in the nation. Both reports used information the news organization ProPublica obtained under the Freedom of Information Act."

The Sun offers a quick retort from the medical director of the pain-management center where Malla practices, paraphrasung him as saying "the reports omit or minimize important factors, such as the specialty of the physicians and the morphine equivalence of the drugs they prescribe."

Dr. Laxmaiah Manchikanti also said in his written statement that his group emphasizes drugs with lower abuse potential and that more than 92 percent of patients at such centers "are already on long-term opioids; consequently, the best we can do (at these centers) is reduce the dosage."

Manchikani is CEO of the American Society of Interventional Pain Physicians, a lobbying group that advocates monitoring of painlkiller prescriptions, and a leading contributor to a wde range of political causes. The Sun doesn't note the latter point, but focuses on the issues of painkiller abuse, a major problem in Kentucky.

"With more than 1,000 deaths per year, Kentucky in 2013 had the third-highest drug overdose mortality rate in the United States, according to the Trust for America's Health," Black notes.

As for the other doctor, the Sun reports, "ProPublica's data on Love, who practices at the Lourdes Pain Management Center, reports that 59 percent of his 1,141 patients filled one or more prescriptions for a Schedule 2 drug and 51 percent filled for a Schedule 3 drug. Both figures are above the average of 45 percent and 41 percent, respectively, for his specialty in Kentucky.

"A spokeswoman for Love said Lourdes center represents the only location in the region where Medicaid patients receive inpatient pain consultations," the Sun reports, quoting her: "The patients we see are often very sick, and the treatments and medications we provide are the last resort comfort measures so the patients can spend quality time with family" as they near death.

The story is behind the Sun's paywall.

Princess Health and State health commissioner backs needle exchanges, most controversial part of anti-heroin legislation passed this year.Princessiccia

Princess Health and State health commissioner backs needle exchanges, most controversial part of anti-heroin legislation passed this year.Princessiccia

drug abuse drugs General Assembly heroin legislation legislature pain clinics state government

Gusty 16:19 Add Comment

The Kentucky General Assembly cracked down in 2012 on "pill mills" that dispense painkillers irresponsibly, and addicts responded by going for heroin, creating a big problem in much of the state. The 2015 legislature passed laws to crack down on heroin, including local needle-exchange programs, the most controversial feature of the package.

In a column distributed to Kentucky newspapers, state Health Commissioner Stephanie Mayfield defends and promotes the local programs, which are subject to local approval.

�To some, a needle exchange may sound like a program that helps intravenous drug users feed their habit,� Mayfield writes. �To the contrary, the intent of an NEP is to protect public health and create a path for heroin users to get treatment while preventing the spread of diseases through the sharing of needles.

Needle exchanges reduce the number of HIV/AIDS and hepatitis cases in a community, Mayfield writes. "The use or even the accidental stick of a dirty needle can lead to hepatitis, HIV/AIDS infection and other dangerous diseases. . . . About 15 percent of all HIV cases that have occurred in Kentucky have been among injecting drug users."

Stephanie M. Gibson

Mayfield also says needle exchanges protecting people from accidental sticks from dirty needles discarded in public places. "Intravenous drug users submit dirty needles to the NEP for proper disposal in exchange for clean needles," she writes. "Researchers have also found that injecting drug users who participated in an exchange were more likely to reduce or stop injecting than drug users who had not participated in a needle exchange."

Research has also shown that needle exchanges "do not encourage the initiation of drug use nor do they increase the frequency of drug use among current users," Mayfield writes, noting that there are 203 such programs in 34 states.

"The presence of NEPs in communities does not expand drug-related networks nor does it increase crime rates. . . . Needle exchange programs actually create a path for injecting drug users to get help because the programs offer information on how to find available treatment options. In fact, NEP participants are more likely to enter a drug treatment program than nonparticipants."

More recent studies show that needle exchanges "provide opportunities for disease testing and education leading to a decline of at-risk behaviors, resulting in HIV incidence dropping as much as 80 percent within this population," Mayfield writes. "Many Kentucky communities are desperate for the ability to reach out to members who suffer from addiction, to help slow the spread of diseases and provide treatment referrals to people they might otherwise never have the chance to reach. This law gives them that opportunity."

Princess Health and Princess Health andMore treatment needed to deal with painkiller abuse, expert witness tells Senate caucus; McConnell says jail helps, too.Princessiccia

Princess Health and Princess Health andMore treatment needed to deal with painkiller abuse, expert witness tells Senate caucus; McConnell says jail helps, too.Princessiccia

pain pain clinics pill mills prescription drug abuse prescription drugs

Gusty 13:00 Add Comment

Addiction to prescription painkillers, and increased addiction to heroin by people originally hooked on prescription medicine, is "a public health disaster of catastrophic proportions" that "was caused by the medical community," the chief medical officer of a New York drug-treatment program said at a U.S. Senate hearing Wednesday.

"The medical community, including dentists, must prescribe more cautiously," Dr. Andrew Kolodny of Phoenix House told the U.S. Senate Caucus on International Narcotics Control. In areas where abuse is rampant, "Treatment capacity does not come close to meeting demand," he said. "If we don't rapidly expand access to treatment, the outlook is grim." He also called for better education of physicians about the risks of prescribing painkillers.

Senate Republican Leader Mitch McConnell of Kentucky attended the first several minutes of the hearing and read a statement calling for the problem to be attacked by a combination of treatment and incarceration, with the use of multi-agency partnerships. He also said, "It's clear that the increase in heroin addiction is tied to our fight against prescription drug abuse."

Part of that fight included requiring Kentucky doctors to participate in the state's prescription-drug monitoring program, which Kolodny said made the state one of only three with such a requirement. The others are New York and Tennessee.

Officials have said that when Kentucky cracked down on disreputable "pill mill" pain clinics, making prescriptions harder to get, addicts turned to heroin. "Heroin is just a symbol for the prescription-drug problem," Joseph Rannazzisi, deputy assistant administrator of the Drug Enforcement Administration, told the senators.

Rannazzisi said the largely successful effort against pill mills in Florida has driven them to Georgia and Tennessee. He said Tennessee has 300 pain clinics. "They're moving north and west," he said. "Regulatory boards in the states need to take control."

Sen. Dianne Feinstein of California, the Democratic co-chair of the caucus, said the testimony made prescription-painkiller and heroin abuse seem worse than the drug problems she dealt with as mayor of San Francisco in the 1980s. "Nothing like today," she said. "I am really struck."

Princess Health and Princess Health andAt National Prescription Drug Abuse Summit, Beshear cites Kentucky's successes.Princessiccia

Princess Health and Princess Health andAt National Prescription Drug Abuse Summit, Beshear cites Kentucky's successes.Princessiccia

controlled substances drugs General Assembly KASPER legislature pain clinics prescription drug abuse prescription drugs state government

Gusty 15:17 Add Comment

Gov. Steve Beshear told attendees at the 2014 National Prescription Drug Abuse Summit in Atlanta on Wednesday about the progress Kentucky has made in the last two years in its battle to combat abuse of prescription drugs.

"Prescription drug abuse was wasting away the future of Kentucky... and collectively, as a state, we decided it was past time to take aggressive action," Beshear said.

Two years ago, Beshear attended the summit  and described a plan; what Kentucky was going to do about prescription drug abuse. Since then, not only has Kentucky implemented an aggressive, strategic plan, it has data showing significant progress.

The plan included increased monitoring of prescriptions, tighter regulations for painkillers, closing pain clinics that did not meet tougher requirements, collecting and disposing of leftover drugs and educating prescribers and the public about the dangerous, addictive nature of these drugs.

The state also set up an electronic prescription drug monitoring system, called KASPER and increased coordination among health regulators and law enforcement both inside Kentucky and with other states.

As for the progress, the evidence is in the numbers. From August 2012 to July 2013, Kentucky saw an 8.5 percent drop in the prescription of controlled substances, Beshear reported, adding that there must have been " a lot of unnecessary prescribing going on."

He also noted the closure of 36 pain clinics that did not meet the new requirements: "They packed up and left, essentially in the dark of the night."

Beshear reported the third area of improvement as less reported abuse of prescription drugs by teen-agers, based on every-other-year surveys of Kentucky 10th graders by Kentucky Incentives for Prevention.

In 2008, 19.3 percent of 10th graders said they had used prescription drugs for non-medical purposes at some point in their lives. In 2012, that number had dropped to 10.4 percent. In 2008, 14.1 percent said they had illegally used prescription drugs in the last month; in 2012, that number dropped to 7.6 percent.

Getting rid of old, unused drugs, whose presence in medicine cabinets can lead to abuse and theft, has also been a strategy of success in Kentucky, Beshear said. He said 172 permanent drop-off sites have been established, with at least one site in 110 of Kentucky's 120 counties.

Beshear also stressed the importance of educating both prescribers and the public. Kentucky's medical community has access to a free, on-line education program and students in Kentucky participate in Keep Kentucky Kids Safe program which has reached 40,000 students so far.

The governor said increased availability of substance abuse treatment is important, and mentioned his expansion of Medicaid under federal health reform. "Access to treatment is at an all-time high in Kentucky, thanks to expanded Medicaid programs and the Affordable Care Act," he said. "There are many addicts who want to get clean, and we�re helping them." For a copy of the speech, click here.

Princess Health and House panel approves bill easing rules of 2012's pill-mill bill.Princessiccia

Princess Health and House panel approves bill easing rules of 2012's pill-mill bill.Princessiccia

doctor shopping drug abuse drugs General Assembly KASPER legislation legislature pain clinics pill mills prescription drug abuse prescription drugs state government

Gusty 13:04 Add Comment

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix �unintended consequences� of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1�s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)