Showing posts with label prescription drug abuse. Show all posts
Showing posts with label prescription drug abuse. Show all posts

Sunday, 19 June 2016

Princess Health and Dangers of HIV and hepatitis from intravenous drug use reach far beyond addicts and families, threatening a wide swath of Ky.. Princessiccia

The growing use of heroin and the abuse of prescription painkillers in Kentucky also mean that the state "is being ravaged by the diseases that follow in their wake: hepatitis and HIV. These dangers also reach far beyond addicts and their families, threatening a wide swath of the population," Laura Ungar reports for The Courier-Journal.

Kentucky has one-fourth of the 220 U.S. counties that the U.S. Centers for Disease Control and Prevention had judged to be at high risk for outbreaks of HIV and hepatitis C among intravenous drug users, Ungar notes in the second installment of a three-part series on heroin in Kentucky and adjoining states.
"Acute hepatitis B rose 114 percent in Kentucky, Tennessee and West Virginia from 2009 to 2013, even as incidence remained stable nationally, according to one study," she reports. "According to another study, the rate of new hepatitis C cases among people 30 and younger more than tripled from 2006 to 2012 in Kentucky, Tennessee, Virginia and West Virginia. More recently, cases of acute hepatitis B and C in Kentucky reached 281 last year, up from 120 in 2003."

Dr. Nora Volkow, director of the National Institute on Drug Abuse, told Ungar that hepatitis C has become the top cause of death from reportable infectious diseases in the U.S., and an HIV outbreak in Austin and Scott County, Indiana, �was a wake-up call� for the country. Ungar notes, "Addicts may also be spreading both diseases without knowing it. Up to three in four people with hepatitis C, and one in eight with HIV, don�t know they have it, experts say."

Dr. William Cooke, an Austin physician "who treats dozens of patients with HIV and hepatitis, said many communities are ill-equipped to handle the threat," Ungar writes. "All over the region and nation, he said, there�s too little substance abuse treatment, too little emphasis on the poverty that often accompanies addiction and too little compassion."

Kentucky has authorized needle exchanges where addicts can get clean syringes to avoid the threat of infection from contaminated needles. "Officials say needle exchanges are an important part of a comprehensive strategy to control disease," Ungar notes. "But critics argue these programs enable drug use, and many area residents reject the idea of using public money to fund them. So the prospect of more syringe exchanges in the region remains uncertain."

Ungar gives the basics of how the diseases spread: "HIV, which can be transmitted through semen and other bodily fluids in addition to blood, is mainly spread by having unprotected vaginal or anal sex with someone who has HIV, or sharing used needles, which can harbor live viruses for up to 42 days. But it also can be transmitted to health care workers by needle sticks, or from mother to child during pregnancy, birth or breastfeeding, especially if the mom isn't taking medicine.

"Hepatitis B and C, which are caused by separate viruses, are easier to catch than HIV because there are higher levels of virus in the blood. Hepatitis B is more often contracted through sex or accidental needle sticks than hepatitis C, but both types are commonly spread by sharing tainted needles."

Thursday, 16 June 2016

Princess Health and  Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

Princess Health and Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

"Accidental overdoses aren't the only deadly risk from using powerful prescription painkillers," The Associated Press reports. "The drugs may also contribute to heart-related deaths and other fatalities, new research suggests."

A study of of more than 45,000 Medicaid patients in Tennessee from 1999 to 2012 found that "those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine," AP reports. "Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients."

"As bad as people think the problem of opioid use is, it's probably worse," said Vanderbilt University professor Wayne Ray, the lead author of the study report. "They should be a last resort and particular care should be exercised for patients who are at cardiovascular risk."

The report in the Journal of the American Medical Association noted that opioids can slow breathing and worsen the disrupted breathing associated with sleep apnea, which could lead to irregular heartbeats, heart attacks or sudden death.

The patients in the study "were prescribed drugs for chronic pain not caused by cancer but from other ailments including persistent backaches and arthritis," AP reports. "Half received long-acting opioids including controlled-release oxycodone, methadone and fentanyl skin patches. . . . There were 185 deaths among opioid users, versus 87 among other patients. The researchers calculated that for every 145 patients on an opioid drug, there was one excess death versus deaths among those on other painkillers. The two groups were similar in age, medical conditions, risks for heart problems and other characteristics that could have contributed to the outcomes."

Tuesday, 14 June 2016

Princess Health and Potent fentanyl, mixed with heroin, drives 14.7 percent increase in fatal drug overdoses in Kentucky from 2014 to 2015. Princessiccia

The number of drug-overdose fatalities in Kentucky rose almost 15 percent in 2015, driven by a 247 percent jump in deaths involving fentanyl, a highly potent opioid that some traffickers are mixing with heroin, the Kentucky Office of Drug Control Policy said Tuesday.

The office counted 1,248 fatal overdoses in Kentucky last year, up 14.7 percent from the 1,088 reported in 2014. Fentanyl was a factor in more than a third: 420, up from 121.

"Heroin was detected in 28 percent of cases, consistent with the previous year," the Justice and Public Safety Cabinet said in a press release. "However, as a total, heroin-related deaths increased in 2015, largely because the drug is being laced with fentanyl."

�The introduction of illicit fentanyl into the heroin trade is producing devastating results,� Van Ingram, director of the office, said in the release. �Whether it�s manufactured to resemble heroin or a prescription pill, the cartels have made an already dangerous situation worse.�

Gov. Matt Bevin said, �I am heartbroken for the Commonwealth. More than three families a day are shattered by this epidemic of untimely death. This is unacceptable and will be vigorously addressed with every resource at our disposal.�

The report by Ingram's office listed the eight counties with the most fatal overdoses per person from 2012 to 2015. All were in Eastern Kentucky or Northern Kentucky. Here are the counties, with the number of deaths per 10,000 people: Leslie, 6.86; Bell, 6.12; Gallatin, 5.26; Knott, 4.87; Wolfe, 4.83; Floyd, 4.76; Campbell, 4.72 per 100,000 and Kenton, 4.63 per 10,000.

Counties with big percentage increases in fatal overdoses from 2014 to 2015 included Bell, from 11 to 20; Boyd, from 13 to 24; Butler, from none to eight; Harlan, from six to 10; Kenton, from 71 to 112; and Rowan, from five to 12.

Counties with large decreases included Bullitt, from 22 to 11; Grant, 13 to 6; Russell, from 13 to 7; Laurel, 18 to 10; Leslie, from nine to five; McCracken, 20 to 10; and Marshall, from 12 to fewer than five. The report does not list specific numbers for a county in years when the county had fewer than five fatal overdoses.

The figures above are based on where the death occurred. Based on the residence of the overdose victim, some counties ranked higher; for example, Powell County had 5.84 overdose deaths per 10,000 people, and Russell County had 4.95. This map shows rates based on the county where the overdose victims resided; note that it shows the death rate per 100,000 people, not 10,000 (a figure closer to the population of most counties). Click on the image for a larger version.

Monday, 13 June 2016

Princess Health and  Doctors trying to reverse course on opioid prescriptions can find it difficult because of addiction, shortage of good alternatives. Princessiccia

Princess Health and Doctors trying to reverse course on opioid prescriptions can find it difficult because of addiction, shortage of good alternatives. Princessiccia

The epidemic of opioid overdoses, 60 percent of which are blamed on abuse or misuse, "is changing prescribing habits, but there's still a lack of other pain medications, access to alternative therapies and knowledge among primary-care providers about multidisciplinary approaches to pain management," Modern Healthcare reports.

"The medical community turned to opioid prescriptions to address a condition many believed had been ignored or undertreated," Steven Ross Johnson writes. "And the dependence on fee-for-service payments also made it easier for providers to whip out their prescription pads rather than spend the time to help patients find alternatives. But experts now say the over-reliance on opioids for chronic pain, despite a lack of evidence on their efficacy and impact, was misguided and has distorted the public's concept of what pain is and what it means to be treated."

But reversing course can be difficult because many patients "have built up resistance to opioids and seek treatment while addicted or at risk of addiction," Johnson reports. He quotes Dr. Neel Mehta, medical director of Weill Cornell Medical College's Pain Medicine Center, which specializes in treating long-term pain as saying many come there because their doctor won't write them another prescription: �So we're sort of left with them expecting to get prescribed an opioid and we have to then calmly redirect that.�

In March the federal Centers for Disease Control and Prevention "recommended doctors prescribe alternative treatments such as over-the-counter medications, cognitive behavioral therapy and exercise before resorting to opioids. Weeks later, the Joint Commission [which accredits health-care facilities] clarified its 2001 standards for pain management and treatment to stress that opioid use was neither required nor specified for treating pain."

Other alternative treatments chiropractic care and the use of anti-inflammatory and neuropathic medications and even vitamin supplements, Johnson notes. "The problem is that few carry the punch or, for some, the pleasure of opioids. . . . The use of medical marijuana, meanwhile, has increased in several parts of the country. It's approved in 38 states and the District of Columbia for patients with illnesses such as cancer and HIV. But only some of those states allow the use of marijuana to relieve chronic pain." Kentucky does not.

Tuesday, 7 June 2016

Princess Health and  Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

By Al Cross
Kentucky Health News

In a state that once had more tobacco farms than any other, Kentuckians in all regions of the state support policies that discourage use of the product, according to the Kentucky Health Issues Poll.

"Such policies could greatly improve Kentucky's overall health," says the Foundation for a Healthy Kentucky, which co-sponsors the poll each fall. It issued a package of reports that broke down a wife range of previously reported poll results on a regional basis.

Kentucky has fewer than 5,000 tobacco farms, down from a high of 60,000 in 1982, but still has one of the nation's highest smoking rates, 26 percent. That leads to an estimated $2 billion in annual health-care costs.

In every region of the state, a majority (ranging from 59 to 70 percent) of people polled said it would be "difficult" or "very difficult" to make the most important change in their personal health behavior, which for most smokers would be to stop smoking.

"Kentucky adults in every region recognize that improving diet, getting more exercise and quitting smoking could help improve personal health, but the changes are difficult," said Susan Zepeda, president and CEO of the foundation. "Policies around these areas could help all Kentuckians improve their personal health."

The policy getting the strongest support in the poll was tobacco-free school campuses, favored by 85 percent statewide. Fewer than a third of Kentucky's school districts have such policies, but enough do to cover almost half the population.

A statewide ban on smoking in workplaces got 66 percent support. Such a ban is unlikely during the administration of Gov. Matt Bevin, who says the issue should be decided locally. About a third of the state's population lives in jurisdictions with comprehensive smoke-free ordinances; another 10 percent or so live in places that have ordinances with varying exceptions.

There was little difference among the five regions in polling on the two issues.

The poll found regional differences in the percentage of Kentucky adults who said they had no insurance, from 18 percent in Western Kentucky to 8 percent in Eastern Kentucky. The statewide uninsured rate reported at the time of the poll was 13 percent. Other surveys have showed the number in the single digits statewide, after expansion of the Medicaid program under federal health reform.

Health reform also provided subsidies for buying insurance, but some consumers have complained about high deductibles and co-payments. In Northern Kentucky, 34 percent of poll respondents said they had difficulties paying their medical bills in the previous 12 months. The figure was 31 percent in Appalachian Kentucky, 30 percent in Greater Louisville, 25 percent in Western Kentucky, and 22 percent in Greater Lexington.

"An increasing number of Kentuckians have health insurance, but many are still delaying or simply can't afford necessary health care," Zepeda said.

Federal health reform was most popular in the Louisville area, at 44 percent support, and least popular in Northern Kentucky, with 33 percent. Generally, the more impact people said reform had on them, the more likely they were to support it. Three of five Northern Kentuckians said they had not been affected by the reforms but only 45 percent in the Louisville area said that.

There are bigger differences in the impact of drug abuse. One-third of Eastern Kentucky residents in the poll reported reported family members or friends struggling with prescription drug abuse, but only 16 percent in Western Kentucky said so.

Heroin use has caused problems for 35 percent of respondents' families and friends in Northern Kentucky, 17 percent in Greater Louisville, 14 percent in Greater Lexington, 10 percent in Eastern Kentucky, and 8 percent in Western Kentucky.

The regional reports for Eastern KentuckyGreater LexingtonGreater LouisvilleNorthern Kentucky, and Western Kentucky, and associated news releases, are available at http://healthy-ky.org/news-events/press-releases.

The poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,608 adults from throughout Kentucky was interviewed by landlines and cell phones. The statewide poll has a margin of error of plus or minus 2.4 percentage points, but the smaller regional samples have higher error margins. The complete data file, codebook and survey instrument will be posted by June 30 at http://www.oasisdataarchive.org/ with other data files from previous polls.

Wednesday, 25 May 2016

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

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.�

Sunday, 22 May 2016

Princess Health and  Nine myths about opioid drug abuse. Princessiccia

Princess Health and Nine myths about opioid drug abuse. Princessiccia

Do you think it's a good idea to save your leftover pain pills to have "just in case" you might need one, or that heroin is primarily an inner-city problem? Think again. Those are among nine common myths that were busted at a community opioid forum in Corbin May 17 in hopes of decreasing some of the stigma that surrounds addiction.

"One of the things we know is that the stigma that exist around opioid abuse is largely propelled because of the myths that exist," said Janet Jones, a representative from Hazelden Betty Ford Foundation, the nation's largest nonprofit addiction treatment provider. Jones led the group discussion about nine opioid myths:

*Myth 1: Abusing prescription painkillers to get high is safer because they are made by a pharmaceutical company and doctors prescribe them.
Fact: Prescription drugs can be just as addictive and just as dangerous as illegal ones, like heroin. The brain and body treats heroin and prescription opioids the same.

*Myth 2: I should save my extra prescription pain pills just in case I need them for something else later, like joint pain or a toothache.
Fact: Saving pain pills that you no longer need can be dangerous because young people often gain access to them. The next time you need pain medication, talk to your health-care provider about the risk, ask them to prescribe only what you need, and properly discard unused drugs when you no longer need them.

*Myth 3: Snorting or smoking heroin or prescription opioids is safer than injecting them.
Fact: There is no "safe" way to abuse a drug. And while injecting drugs with shared needles increases the risk of HIV/AIDS or hepatitis C, any method of opioid abuse can lead to overdose and death.

*Myth 4: Heroin is primarily an inner-city problem.
Fact: Heroin use is on the rise nationwide, including in suburban and rural areas.

*Myth 5: A person addicted to heroin or prescription painkillers is a lost cause.
Fact: Treatment works. Recovery is possible with appropriate treatment and adequate social support systems.

*Myth 6: Heroin and prescription pain pills are just the latest "fad" drugs and their appeal will fade.
Fact: Opium, heroin and other opioids have been used for thousands of years. Prescription opioids have a legitimate use as effective painkillers and are not going away any time soon. And while illegal drugs come and go, communities are experiencing unprecedented use of opioid drugs, and people are dying at epidemic levels

*Myth 7: Making Narcan (naloxone) available to first responders wastes resources on people who have given up, and takes away an addict's incentive to quit by making them less likely to die of an overdose.
Fact: Addiction is a chronic disease, not a moral flaw, and the only way a person can get help is if they are alive to do so. Time is critical to overdose survival rates and naloxone helps to save these lives.

*Myth 8: Heroin and prescription painkiller abuse only hurts those who use the drug.
Fact: Opioid abuse hurts everyone. Financially, the legal, healthcare and lost productivity costs total in the billions and the intangible costs to families and friends are incalculable.

*Myth 9: Hardworking everyday people don't use heroin or misuse prescription painkillers.
Fact: Any type of person can develop an opioid use disorder.

Saturday, 7 May 2016

Princess Health and In many people, OxyContin doesn't give 12-hour pain relief as advertised, and that can cause an addiction problem. Princessiccia

Oxycontin tablets (Los Angeles Times photo by Liz Baylen)
Why have so many people become addicted to the painkiller OxyContin? We know about the overselling of the drug by its manufacturer, Purdue Pharma, which cost the company $635 million in 2007 to settle an investigation by the Department of Justice. Now the Los Angeles Times reports on another big reason, which the settlement didn't address: In many people, OxyContin doesn't last as long as advertised, and "Patients can experience excruciating symptoms of withdrawal, including an intense craving for the drug," Harriet Ryan, Lisa Girion and Scott Glover report.

Purdue Pharma "launched OxyContin two decades ago with a bold marketing claim: One dose relieves pain for 12 hours, more than twice as long as generic medications," the writers report. "On the strength of that promise, OxyContin became America�s bestselling painkiller, and Purdue reaped $31 billion in revenue."

However, the Times reports, "Even before OxyContin went on the market, clinical trials showed many patients weren�t getting 12 hours of relief," as the company claimed. "Since the drug�s debut in 1996, the company has been confronted with additional evidence, including complaints from doctors, reports from its own sales reps and independent research. The company has held fast to the claim of 12-hour relief, in part to protect its revenue. OxyContin�s market dominance and its high price � up to hundreds of dollars per bottle � hinge on its 12-hour duration. Without that, it offers little advantage over less expensive painkillers."

In the late 1990s, when doctors began telling patients to take OxyContin at shorter intervals, "Purdue executives mobilized hundreds of sales reps to [refocus' physicians on 12-hour dosing. Anything shorter 'needs to be nipped in the bud. NOW!!' one manager wrote to her staff," the Times reports. "Purdue tells doctors to prescribe stronger doses, not more frequent ones, when patients complain that OxyContin doesn�t last 12 hours. That approach creates risks of its own. Research shows that the more potent the dose of an opioid such as OxyContin, the greater the possibility of overdose and death. More than half of long-term OxyContin users are on doses that public-health officials consider dangerously high, according to an analysis of nationwide prescription data conducted for The Times."

More than 7 million Americans have abused OxyContin in the last 20 years, according to the National Survey on Drug Use and Health, and a disproportionate number have been in Appalachia and Eastern Kentucky, where the drug has been called "hillbilly heroin." OxyContin "is widely blamed for setting off the nation�s prescription opioid epidemic, which has claimed more than 190,000 lives from overdoses involving OxyContin and other painkillers since 1999," the Times reports.

Purdue Pharma issued statement calling the Times story �long on anecdotes and short on facts� and said it was based on a �long-discredited theory.� Times spokeswoman Hillary Manning replied, �Our editors see nothing in Purdue�s statement that casts doubt on our reporting or our findings.� For details, click here.

Tuesday, 3 May 2016

Princess Health and Prescription drug addiction not only comes at a personal cost to individuals, but also at an enormous cost to employers. Princessiccia

By Melissa Patrick
Kentucky Health News

With nearly one of three opioid prescriptions being abused, employers are not only subsidizing the cost of these drugs, they are also paying for the fallout that results from the abuse, according to a new study.

"The personal impact that opioid painkiller abuse takes on individuals, their friends, and family is absolutely tragic,� Kristin Torres Mowat, senior vice president of health plan and strategic data operations for Castlight Health, the health-information firm that led the study, said in a news release. �This crisis is also having a significant impact on the nation�s employers, both in the form of direct and indirect costs. From higher spending on healthcare, to lost productivity, to the dangers associated with employees abusing medications in the workplace: these are aspects of the crisis that are too often overlooked in the current discussion.�

The study, titled "The Opioid Crisis in America's Workforce," looked at anonymous claims data from nearly a million employer-based health insurance claims between 2011 and 2015, defining abuse as those who received more than a 90-day supply of opioid prescriptions and received prescriptions from four or more providers. It excluded claims that had cancer, palliative care or convalescence care diagnoses.

Graph from "The Opioid Crisis in America's Workforce" report
The study found that 22 of the top 25 cities that abuse opioids are in the rural South. Henderson was the only Kentucky town on this list, as part of the Evansville, Ind., metropolitan area, which had a 7.8 percent opioid abuse rate.

Kentucky ranks fourth in the nation for painkiller prescriptions, at about 130 prescriptions for every 100 people, Christine Vestal reports for Stateline.

So why aren't more Kentucky towns on the list? "Anywhere with a ZIP code is included," Castlight spokeswoman Cynthia Cowen said in an email. "However, in less populated regions, showing the abuse rates may inadvertently lead to patient identification."

The Castlight study also found that on average, 4.5 percent of Americans who get narcotic painkiller prescriptions are abusers, and account for nearly one-third (32 percent) of total opioid prescriptions and 40 percent of opioid prescription spending.

And the cost to employers is huge, estimated at $10 billion annually for absenteeism and poor work productivity, says the report. In 2015, the study found that employers spent nearly twice as much ($19,450) in medical expenses on opioid abusers annually than on non-abusers ($10,853), a difference of $8,597.

The study offered some additional insights, including: baby boomers are nearly four times more likely to abuse opioids than Millennials; poorer people are twice as likely to abuse opioids as rich ones; states with medical marijuana laws have a lower opioid abuse rate than those that don't; patients with a behavioral health diagnosis of any kind are three times more likely to abuse opioids than those without one; and opioid abusers have twice as many pain-related conditions as non-abusers.

The federal Centers for Disease Control and Prevention has called this issue a public-health crisis and has asked doctors to change the way they prescribe opioids, by only prescribing them for three to seven days at the lowest possible effective dose.

According to the CDC, nearly 2 million Americans are abusing prescription opioids, resulting in 16,000 deaths per year. In 2014, the latest data available, 1,087 Kentuckians died of overdoses, according to the Kentucky Office of Drug Control Policy.

The report suggests that employers have a role to play in addressing this through the use of data and analytics to determine prescribing trends that can then help them better understand what their employers needs are as they relate to opioid use and abuse, and then to guide them to appropriate benefit programs to prevent or treat their addictions.

Thursday, 31 March 2016

Princess Health and Obama joins Rogers at National Rx Drug Abuse and Heroin Summit, says it's time to focus on treatment over incarceration. Princessiccia

By Melissa Patrick
Kentucky Health News

The fifth annual national summit on prescription drug abuse, started by U.S. Rep. Hal Rogers of Kentucky, was the largest, broadest and highest-profile yet.

A non-prescription drug was added to the title of the four-day event, making it the National Rx Drug Abuse and Heroin Summit. It drew more than 1,900 to Atlanta, including President Barack Obama, who joined an hour-long panel to talk about new ways to deal with a growing opioid and heroin epidemic.

U.S. Rep. Hal Rogers
"The rapid growth of this summit is truly a testament to the power of unity. Everyone here has one common goal - to save lives from the dark clenches of drug abuse," Rogers, a Republican from Somerset, said in a news release.

The summit was hosted by Operation UNITE, a Kentucky non-profit created by Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.

According to the federal Centers for Disease Control and Prevention, in the U.S. someone dies every 20 minutes from an opioid overdose and Kentucky has one of the nation's highest rates, with more than 1,000 deaths a year from it.

(On Monday, April 4, KET's "Kentucky Tonight" will have a report on the summit and a look back at the network's coverage of drug addiction issues. For a preview from host Bill Goodman, click here.)

The University of Kentucky and UK HealthCare, which helped sponsor the summit, sent a delegation of executive, clinical and research leaders, including President Eli Capilouto as one of the keynote presenters, according to a UK news release.

�Too many Kentucky families are too often confronted by the dark and painful scourge of prescription drug abuse and opioid addiction," Capilouto said. "It�s an epidemic that penetrates communities across the nation, both urban and rural, but has especially intractable roots in Appalachia and the regions served by the University of Kentucky.�

Obama opened his remarks on the panel by thanking Rogers,who is also co-chair of the Congressional Caucus on Prescription Drug Abuse, and UNITE, "the organization that has been carrying the laboring oar on this issue for many years now. We are very grateful to them."


Obama focused some of his comments on broadening access to medication-assisted treatments for addiction, most successfully with counseling and behavior therapy.

"What we do know is that there are steps that can be taken that will help people battle through addiction and get onto the other side, and right now that's under-resourced," the president said.

Obama's administration recently proposed doubling the number of patients a health-care provider can treat with buprenorphine, one of the drugs used to fight addiction, to 200 from 100.

He said the opioid and heroin epidemic is a public-health issue and not just a criminal-justice problem, which is the only way to reduce demand. "In this global economy of ours that the most important thing we can do is to reduce demand for drugs," he said.

Because the opioid and heroin epidemic is touching everybody and not just poor people and minorities, there is now more emphasis on treatment over incarceration, Obama said: "This is not something that's just restricted to a small set of communities. This is affecting everybody -- young, old, men, women, children, rural, urban, suburban."

The president also noted that there has been a significantly increase in opioid abuse in rural areas, which often suffer from an under-resourcing of treatment facilities and mental health services.

"And that's why, for all the good work that Congress is doing, it's not enough just to provide the architecture and the structure for more treatment. There has to be actual funding for the treatment," he said.

The president has proposed $1.1 billion in his upcoming fiscal year 2017 budget request to fund drug-treatment programs in counties all across the country.

Agriculture Secretary Tom Vilsack announced two rural initiatives at the summit: town hall meetings in rural areas hit hardest by drug abuse, including Appalachia, "to raise awareness of the issue and discuss possible solutions," and an extension of the Rural Health and Safety Education competitive grant program to include $1.4 million in grants that will now be available to rural communities to fight heroin and painkiller abuse, according to a press release.

The president also announced several other new initiatives: establishing a Mental Health and Substance Disorder Parity Task Force; implementing mental health and substance use disorder parity in Medicaid; releasing $11 million for the purchase and distribution of the opioid-overdose reversal drug, naloxone; expanding an initiative that improves local partnerships between law enforcement and public health; a $7 million investment for community policing to address heroin; and providing guidelines for the use of federal funds to implement or expand needle-exchange programs.

Wednesday, 16 March 2016

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

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.

Thursday, 10 March 2016

Princess Health and  McConnell touts bill to fight opioid abuse; blocks extra funding, says money is available and more should require cuts elsewhere. Princessiccia

Princess Health and McConnell touts bill to fight opioid abuse; blocks extra funding, says money is available and more should require cuts elsewhere. Princessiccia

The U.S. Senate passed a bill 94-1 March 10 aimed at "the growing epidemic of painkiller and heroin abuse," Karoun Demirjian reports for The Washington Post. "Drug abuse has been in the spotlight this political season, with presidential candidates recalling personal stories about relatives and friends who struggled with addiction and lawmakers from states dealing with the crisis highlighting their efforts to address the problem legislatively."

Kentucky Sen. Mitch McConnell, as majority leader, helped lead the effort to pass the bill, along with fellow Republicans who "face tough re-election battles" and whose losses could cost the GOP its majority, Demirjian notes. Sens. Kelly Ayotte (R-N.H.) and Rob Portman (R-Ohio) "supported a Democratic-led, and ultimately unsuccessful, effort last week to add $600 million to the bill to support the treatment and prevention programs it would create." So did Sen. Mark Kirk (R-Ill.), "who is also facing a formidable election challenge."

McConnell opposed the funding amendment, saying there is enough money for the programs already and extra funding must be offset with budget cuts elsewhere. "Senators are now eyeing the appropriations process as the next place they intend to appeal for more drug abuse treatment and prevention funding," Demirjian reports.

McConnell said in a press release, "At a time when more Kentuckians now die from drug overdoses than car crashes, it�s clear that more action is needed."

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, told Beth Warren of The Courier-Journal, �One of the nice things this bill does is sets some standards around treatment.�

"The legislation would establish grant programs to help state and local governments improve education and treatment for drug abuse, encourage medical providers to reduce unnecessary prescriptions, commit resources to help veterans deal with addiction, and give local law enforcement and mental health officials tools to lower the death rate from overdoses," the Post reports. "A key provision would provide states with incentives to make naloxone, which can counteract overdoses, more widely available by offering liability protections to officials who distribute it. The bill�s fate in the House remains unclear."

Saturday, 20 June 2015

Princess Health and Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud.Princessiccia

Former Dr. Fred Gott of Bowling Green was arrested.
(Photo: Miranda Pederson, Bowling Green Daily News)
Twelve people in the western half of Kentucky, including three doctors, have been charged with Medicaid fraud in what the federal government calls its biggest-ever "takedown" of the problem, Andrew Wolfson of The Courier-Journal reports.

The indictments allege "a half-dozen schemes involving nearly $8 million in alleged fraudulent billings," Wolfson writes. "The offenses include $5 million in false billings for muscle-relaxant injections that were never delivered to patients, as well as a staged car wreck in which three people allegedly conspired to get controlled substances and fraudulent reimbursements."

In another case, Wolfson reports, "a medical practice that treated car wreck patients is accused of using the DEA numbers of nurse practitioners to order hydrocodone for herself and falsely billing it to an insurance company. Nationally, the sweep resulted in charges against 243 people, including 46 doctors, nurses and other licensed medical professionals."

John Kuhn, acting U.S. attorney for the Western District of Kentucky, told Wolfson that about $1 billion of annual Medicare and Medicaid expenses are fraudulent. Medicare is the federal health-insurance program for people over 65; Medicaid is the federal-state program for the poor and disabled.

Former Dr. Fred Gott of Bowling Green, a 63-year-old cardiologist, was charged with "conspiracy to dispense controlled substances, health care fraud and money laundering," Deborah Highland reports for the Bowling Green Daily News. "The Bowling Green-Warren County Drug Task Force opened an investigation into Gott�s practices after Warren County Coroner Kevin Kirby alerted the task force about drug overdose deaths involving Gott�s patients, task force director Tommy Loving said."

Sunday, 31 May 2015

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

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.

Monday, 11 May 2015

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths�a majority of which are from prescription drugs�in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."

Thursday, 2 April 2015

Princess Health andPolling shows Kentucky ranks third in share of residents, 24.5 percent, who say they take mood-altering drugs every day.Princessiccia

Kentucky is the place to be for mood-altering drugs. The state ranked third in a Gallup Organization study that asked 450 adults in each state how often they use drugs and medications to affect their mood or relax them, Christopher Ingraham reports for The Washington Post. West Virginia led, with 28.1 percent of respondents saying they use mood-altering drugs every day, Rhode Island was second at 25.9 percent, but Kentucky was not far behind at 24.5 percent.

Nationally, 18.9 percent of respondents said they take drugs almost every day, while 62.2 percent said they never do, 13.1 percent said they rarely do and 5 percent said they sometimes do.

The way the question was worded allows for errors, Ingraham writes. The question asked about drugs and medications, but didn't specify which ones, and didn't mention alcohol or tobacco. That left interpretation of the question up to individual respondents.

A recent National Survey of Drug Use and Health said that at least 71 percent of American adults drank in the past year, and 56 percent drank in the past month, which if true, could raise the rates in most states, if respondents were to consider alcohol a mood-altering drug. (Read more) (To view this interactive Post map click here)

Wednesday, 28 May 2014

Princess Health and Princess Health andNew rule allows Medicare to drop doctors for irresponsible prescribing.Princessiccia

Princess Health and Princess Health andNew rule allows Medicare to drop doctors for irresponsible prescribing.Princessiccia

Medicare physicians who prescribe drugs in abusive ways can now be expelled by the federal government, Charles Ornstein reports for ProPublica.

This increased oversight of Medicare Part D prescribers could help decrease the availability of prescription drugs to abusers in Kentucky. More than 1,000 Kentuckians die each year from prescription drug overdoses, and the state has the third-highest overdose death rate in the nation.

Opoids, which are often found in pain medicine, are the most commonly abused prescription drugs, according to the National Institute on Drug Abuse. Hydrocodone, an opoid, is the most commonly prescribed controlled substance in Kentucky, according to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, and is also the most prescribed drug in Part D program, according to ProPublica's Prescriber Checkup, a tool that compares physicians' prescribing patterns among specialties and states.

The Centers for Medicare and Medicaid Services proposed the new rule after ProPublica documented "how Medicare's failure to oversee Part D effectively had enabled doctors to prescribe inappropriate or risky medications, had led to the waste of billions of dollars on needlessly expensive drugs and had exposed the program to rampant fraud," Ornstein writes.

Part D covers 37.5 million seniors and disabled patients, and one in every four prescriptions in the U.S. is paid for by Medicare, costing taxpayers $62 billion in 2012, and experts have complained that Medicare is more interested in providing drugs to patients than in targeting problem prescribers, Ornstein notes. The U.S. Department of Health and Human Services' inspector general has called for tighter controls.

The new rule allows Medicare to drop doctors "if it finds their prescribing abusive, a threat to public safety or in violation of Medicare rules," or if their Drug Enforcement Administration registration certificates are suspended or revoked, Ornstein writes. Problem providers will be identified by prescribing data, disciplinary actions, malpractice lawsuits and other information.

Opponents of the rule have called its definition of "abusive" prescribing too vague. Some worry that patients will lose access to necessary medication if their doctor is removed from the program, Ornstein writes. Medicare officials said they intend to expel providers only in "very limited and exceptional circumstances," saying "It will become clear to honest and legitimate prescribers . . . that our focus is restricted to cases of improper prescribing that are so egregious that the physician or practitioner's removal from the Medicare program is needed to protect Medicare beneficiaries."

The new rule also allows the Medicare center to "compel health care providers to enroll in Medicare to order medications for patients covered by its drug program, known as Part D," Ornstein writes. Now, doctors not enrolled in Medicare can prescribe for Part D patients; they will have to enroll or opt out of the program by June 1, 2015.

The doctors most affected by this will be dentists and Department of Veterans Affairs physicians who provide services not covered by Medicare but have patients who fill prescriptions covered by the program, Ornstein notes. Most health providers are already enrolled. (Read more)

Wednesday, 14 May 2014

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

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."

Wednesday, 23 April 2014

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

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.

Sunday, 16 March 2014

Princess Health and Princess Health andNumber of Kentucky babies born addicted keeps rising quickly as heroin replaces harder-to-get prescription painkillers.Princessiccia

Despite the crackdown on prescription painkillers, more Kentucky babies are being born addicted, "fueled by a recent spike in heroin use," much of it by people who have found prescription painkillers harder to get, Laura Ungar reports for The Courier-Journal.

"The state has seen hospitalizations for drug-dependent newborns soar nearly 30 fold in a little more than a decade � from 28 in 2000 to 824 in 2012, according to a recent drug report from the Kentucky Injury Prevention and Research Center. Preliminary figures suggest that number will surpass 900 in 2013, according to state officials," Ungar reports, in a follow-up to a series she did on the state's prescription-drug abuse problems in 2012.

"The financial cost is also high � and climbing exponentially," Ungar writes. "Hospital charges for drug-dependent babies in Kentucky rose from $200,000 in 2000 to $40.2 million in 2012, with $34.9 million that year paid for by government Medicaid," nearly 30 percent of which comes from Kentucky taxpayers.

"Although there are no state-by-state statistics, Dr. Henrietta Bada, a neonatal-perinatal medicine doctor at the University of Kentucky, said she believes Kentucky has one of the nation�s worst problems with drug-dependent babies." the Journal of the American Medical Association reported that U.S. hospitalizations for drug-dependent babies rose 330 percent from 2000 to 2009; "Kentucky�s hospitalizations rose more than 1,400 percent during that same time," but the state has "only 55 treatment centers serving pregnant and postpartum women, the vast majority outpatient facilities," Ungar reports. That's �a fraction of what we need,� Attorney General Jack Conway told her.