4 of 5 Kentuckians think child obesity is a problem, and more than half favor a statewide smoking ban, poll finds

More than four out of five Kentuckians think too many children are overweight, and more than half want a statewide smoking ban. These are two of key findings of the Kentucky Health Issues Poll, which also asked respondents about prescription drug abuse, depression and access to health care.

Poll findings are available by clicking here. Findings have been broken down by region: Western Kentucky, greater Louisville, greater Lexington area, Northern Kentucky and Eastern Kentucky.

Statewide, the poll found 54 percent of Kentuckians favor a statewide smoking ban, up from 53 percent the year before. In 2010, Kentuckians were split down the middle, 48 percent to 48 percent.

A whopping 84 percent of Kentuckians feel childhood obesity is a problem, which is timely since 33 percent of children, 60 percent of women and 80 percent of men in Kentucky are overweight or obese, "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" reports.

The poll also found more than one in three Kentuckians know someone who has misused prescription drugs; 65 percent of adults dispose of their prescription drugs in an unsafe way; nearly half keep guns in their homes; and 1 in 2 Kentuckians have a family member or friend with a serious problem of depression. Nearly 90 percent of people asked favor providing access to affordable, quality health care for all Americans.

"The Kentucky Health Issues Poll provides an excellent snapshot of how various health related issues are viewed throughout the commonwealth," said Dr. Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which helped fund the poll. "The survey's methodology lets us compare responses and learn about regional differences in Kentucky views about health."

The poll was also funded by The Health Foundation of Greater Cincinnati. It was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews.

State prescription drug databases like KASPER cut back doctor shopping and drug abuse, new study shows

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Research from the University of North Carolina indicates drug databases like the Kentucky All Schedule Prescription Electronic Reporting system do reduce doctor shopping and change prescribing behavior.

Another article showed state drug databases "facilitate a relative decrease over time in prescription drug misuse, despite state differences in program administration," reports Maggie Clark for Stateline, the freshly revised news service of The Pew Center on the States.

A 2010 evaluation of KASPER showed 90 percent of doctors who used the system found it effective in preventing drug abuse and doctor shopping. A new Kentucky law "mandates that all physicians and pharmacists who prescribe schedule II and III drugs, such as oxycodone and hydrocodone, check the patient's prescription records before writing or filling a prescription," Clark reports. Dispensers must also register prescriptions in the state database without 24 hours of writing or filling the prescription.

Clark points out the legislation change sparked a debate about "how to balance patient privacy and law enforcements needs in fighting a serious criminal and public health problem." Attorney General Jack Conway, who wanted KASPER put into his office's hands, lost that fight as part of the legislative compromise. It will remain the responsibility of the Cabinet for Health and Family Services and, by extension, the doctor-run Kentucky Board of Medical Licensure.

Privacy issues have likewise surfaced in Vermont. "The discussion really is about what kind of access the police will have to electronic personal health information," said Allen Gilbert, executive director of the Vermont Civil Liberties Union. (Read more)

Beshear OKs prescription bill, telling pill mills, 'Get out of this state'

Saying it couldn't get to his desk quickly enough, Gov. Steve Beshear signed a bill aimed at curbing prescription drug abuse in celebration today, warning so-called pill mills to "Get out of this state, because we're coming after you."

House Bill 1 requires doctors and pharmacists who prescribe or dispense Schedule II and III drugs, such as oxycodone and morphine, to use the Kentucky All Schedule Prescription Electronic Reporting system and requires pain clinics to be owned by at least one physician. Clinics already in operation that have not had trouble with the law but are not owned by doctors will be grandfathered in under the law.

Though there was a strong push for it by law enforcement, the bill will not move KASPER over to the attorney general's office but will stay under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure.

House Speaker Greg Stumbo, who sponsored the bill, called the legislation "a major step forward in the ongoing battle to put the brakes on prescription drug abuse."

Though KASPER will not move to  Attorney General Jack Conway's office, as Conway wanted, he endorsed the effort. "It helps keep entrepreneurs out of the pill mill business and requires doctors, with reasonable exceptions, to use the KASPER system," he said. "I encourage those who are fearful of increased oversight to end the hyperbole and begin a constructive process with the legislature and executive branch to implement this bill." (Read more)

1 in 4 grandparents keep meds where kids can reach them

A new poll shows nearly one in four grandparents say they store prescription medicines in places that can be accessed by children. Unintentional poisonings cause more visits to the emergency room for young children — one every 10 minutes — than car accidents, to say nothing of the threat of theft, a factor in the prescription-drug epidemic that is killing more Kentuckians than such accidents.

The most common type of prescriptions that are accidentally ingested are opioids, the poll found. The most common type of over-the-counter medicine ingested is acetaminophen, the active ingredient in Tylenol, reports research-reporting service Newswise.

The poll found that 23 percent of grandparents and 5 percent of parents store prescription meds in easy-to-access places. Eighteen percent of grandparents and 8 percent of parents said they store over-the-counter medicine in easily accessible spots.

"Emergency room visits for accidental poisonings among young children have become much more frequent in the last decade," said Matthew Davis, director of the C.S. Mott Children's Hospital National Poll on Children's Health. "We hope the results of this poll are a reminder to parents, grandparents and all those who care for young children: check around your homes to make sure that medicines are safely stored out of reach." (Read more)

Though the numbers are on the rise, on the whole, American children are safer than they ever were, according to the Centers for Disease Control and Prevention. The rate of death from unintentional injuries dropped 29 percent from 2000 to 2009. Deaths dropped from 12,400 in 2000 to about 9,100 in 2009.

Poisoning death rates rose dramatically, however‚ going up 91 percent in youths aged 15 to 19, "a byproduct of the rising prescription-drug abuse among teens who either obtain the pills illegally or swipe them from medicine cabinets of their parents or others," reports Timothy Martin for The Wall Street Journal. (Read more)

Docs must stop over-prescribing pain pills, summit speakers say

When a statistic showed the number of opioid prescriptions increased from 76 million in 1991 to 219 million in 2011, Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, asked the seminal questions: "Do we really have this number of people requiring these prescriptions? Have we increased four times in terms of chronic pain? That's clearly not the case."

Dr. Ileana Arias, principal deputy director of the Centers for Disease Control and Prevention, said "opioid overdose death rates have risen in lock step with sales," reports Laura Ungar for The Courier-Journal. "In 2010, enough prescription painkillers were prescribed to medicate every American adult around the clock for a month."

These were more troubling statistics discussed at the National Rx Drug Abuse Summit, held in Orlando, Fla., and organized by Eastern Kentucky's Operation UNITE. "This is an epidemic. And at CDC, we do not use the word epidemic very lightly," Arias said.

Volkow pointed out opioids are very addictive, since they raise dopamine levels in the brain, which are triggered when people do pleasurable activities, such as eating or sex. Heroin and the painkiller OxyContin are nearly identical in their chemical structure, she said. OxyContin blocks pain but increases dopamine. "You are decreasing pain, but you are activating a reward," she said.

Treatment is one solution, but "we don't have sufficient treatments. We are far behind other conditions," such as cancer or HIV, Volkow said.

More research is needed to "develop better pain medications that are as effective as opioids that are not addictive," she added. Doctors also need to be aware of over-prescribing, with Arias recounting a story in which she was prescribed two-weeks worth of Demerol after she had her wisdom teeth taken out — an excessive amount, in her view.

U.S. Rep. Harold "Hal" Rogers of Kentucky's 5th District said he wasn't surprised. "Time and again, we've heard that doctors have prescribed, say, two weeks of medication when only a few days are necessary," he said. "Then the rest go in a medicine cabinet for (others) to pilfer." (Read more)

Troubling statistics discussed at prescription-drug summit

Staggering statistics were revealed this week at the Orlando-based National Rx Drug Abuse Summit, including one survey that found 2 million people age 12 and older started using prescription pain medicine for non-medical reasons in 2010. A troubling 11 percent of active-duty military personnel reported misusing pain medicine in the past month, Department of Defense research shows. And more than 15,000 people die each year because of pain killers, 1,000 of whom are Kentuckians, reports Laura Ungar of The Courier-Journal.

"Prescription-drug abuse is causing untold misery among our families," Gov. Steve Beshear said at the gathering, which was organized by Eastern Kentucky-based Operation UNITE. The problem is "wasting away the future of many people in the Commonwealth of Kentucky."

As he's done several times now, Beshear asked conference attendees to push legislators to pass House Bill 4, which should be voted on today in Frankfort. The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney genera's office from the Cabinet for Health and Family Services.

Experts said prevention is key, which involves education youth, parents, as well as doctors and pharmacists. U.S. Surgeon General Dr. Regina Benjamin doctors "need to be more cognizant of the problem," Ungar reports, recounting an incident in which a patient stole one of her prescription pads by using her 4-year-old daughter to district Benjamin.

Gil Kerlikowske, known as the country's "drug czar," said general practitioners and family medicine doctors accounted for 27 percent of all prescribers of extended-release, long-acting opioids. Internal medicine physicians were the most common specialists to prescribe, accounting for almost 17 percent of prescriptions of pain pills.

One of the problems, Kerlikowske said, is prescription drug abuse is considered more acceptable than taking other kinds of drugs. Children "see their parents taking it. It's not heroin. It's not coke." (Read more)

Beshear tells national audience legislature should pass pill-mill bill

Today, Gov. Steve Beshear again called on legislators to pass a bill Thursday that would crack down on so-called pill mills and thus curb prescription drug abuse. Speaking at the National Prescription Drug Abuse Summit in Orlando, Beshear asked for comprehensive collaboration to fight the problem, which kills more Americans than car accidents.

"No state or community is an island. It will take all of us — working across geographical and agency borders — to make headway against prescription drug abuse," he said.

The three-day summit is sponsored by Operation UNITE, which serves Kentucky's Fifth Congressional District, and features 100 leaders and experts, including Surgeon General Regina Benjamin, Office of National Drug Control Policy Director Gil Kerlikowske, Fifth District Rep. Hal Rogers, and Centers for Disease Control Principal Deputy Director Illeana Arias.

Beshear outlined what has already been implemented in Kentucky to combat the problem, including working with Ohio, Tennessee and West Virginia to identify those who exploit the system by crossing state borders and forming a panel of health professionals to develop criteria to identify suspicious drug-prescribing habits. But he also stressed the importance of passing House Bill 4, which would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure and the Cabinet for Health and Family Services.

The latter provision continues to draw opposition from the Kentucky Medical Association, which is lobbying hard to make changes to the bill, or perhaps kill it. Beshear has been touting the bill, considered the cornerstone of this year's General Assembly, since before it was filed. Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, said on KET's "Comment on Kentucky" Friday night that if the bill does not pass, the legislative session will be a failure. (Read more)

Pain-pill problem has spread to new areas from Appalachia

Sales of hydrocodone (the key ingredient of Vicodin, Norco and Lortab) and oxycodone (the main ingredient in OxyContin, Percocet and Percodan) skyrocketed in new parts of the country as the problem spread from its Appalachian roots in the last decade, an Associated Press analysis shows.

Oxycodone sales in Tennessee, New York and Florida were up by more than 499 percent from 2000 to 2010, the highest increases in the country, the study shows. When it came to hydrocodone, South Dakota had the highest increase, with 300 to 399 percent.

In Kentucky, oxycodone sales increased by 171 percent and hydrocodone sales increased 176 percent from 2000 to 2010. Kentucky's increase was not as high because the problem started in the eastern part of the state and in West Virginia, with coal miners needing relief from back and chronic pain, reports the AP's Chris Hawley. The problem also started in affluent suburbs, said Pete Jackson, president of Advocates for the Reform of Prescription Opioids. "Now it's spreading from those two poles," he said.

In 2010, pharmacies dispensed 69 tons of oxycodone and 42 tons of hydrocodone nationwide. "That's enough to give 40 5-milligram Percocets and 24 5-milligram Vicodins to every person in the country," Hawley reports.

As sales increase, so do overdose deaths and pharmacy robberies, Hawley reports. Opioid pain relievers, a category that includes oxycodone and hydrocodone, caused 14,800 overdose deaths in 2008 and numbers are rising, according to the Centers for Disease Control and Prevention.

Part of the increase in sales can be blamed on the fact that the U.S. population is aging, resulting in more pain issues. There is also more of a willingness by doctors to treat pain, said Gregory Bunt, medical director at New York's Daytop Village chain of drug treatment clinics. But they're also increasing because people are addicted. "We all recognized that these drugs can be just as dangerous and deadly as illicit substances when misused or abused," said Gil Kerlikowske, the U.S. drug czar.

The AP analysis used drug data collected four times a year by the Drug Enforcement Adminstration's Automation of Reports and Consolidated Orders System. "The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes," Hawley writes. "Every ZIP code starting with 100-, for example, is lumped together into one figure."

ZIP codes that include military bases or Veterans Affairs hospitals have had large increases because of treatment of injured soldiers. Some areas are affected because mail-order pharmacies have shipping centers there. Areas with large Indian reservations also had larger numbers.

The most sweeping trend, though, is how the pain pill epidemic has spread to areas previously untouched. In 2000, Florida's oxycodone sales were centered around West Palm Beach. By 2010, they were common in almost every part of the state. It has become commonplace in New York City and its suburbs. Staten Island alone saw a sales jump of 1,200 percent. And Tennessee had a five- to six-fold increase in that decade. "We've got a problem. We've got to get a handle on it," said Tommy Farmer, a counterdrug official with the Tennessee Bureau of Investigation. (Read more)

For a view of an interactive map that shows more Kentucky numbers, click here.

Doctors' lobby still working for changes in 'pill mill' legislation

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, “We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.”

The KMA’s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet’s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, “The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.”

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill’s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

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

In bipartisan way, political leaders push passage of 'pill mill' bill

A bipartisan group of political leaders issued a call today "to pass a bill that will help the state battle one of its most significant threats – prescription drug abuse," a press release from Gov. Steve Beshear's office said. Beshear, Attorney General Jack Conway, House Speaker Greg Stumbo, Senate Republican Floor Leader Robert Stivers, Sen. Jimmy Higdon, R-Lebanon, and House Judiciary Committee Chairman John Tilley, D-Hopkinsville, said the legislature should pass House Bill 4 when it returns to Frankfort for its final day April 12.

"Since the beginning of 2012, more than 400 Kentuckians have been hospitalized because of prescription drug overdoses – a statistic that the leaders say underscores the crucial need to pass this bill in this legislative session," the release said. "Kentucky has the nation’s sixth-highest rate of prescription drug overdose deaths, at nearly 18 deaths per 100,000."

Conway said in the release, “I'm hopeful everyone, including the medical community, can get on board with House Bill 4 to ensure that we don't lose another generation in Kentucky to prescription drug abuse.” The bill would move the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to Conway's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has done little to rein in "pill mills" that churn out prescriptions for painkillers.

"Law enforcement members warn that Ohio, Tennessee, West Virginia and Florida have passed legislation similar to HB 4 to address pill mills, and failing to pass similar legislation could create a diversion effect in which Kentucky could become a source state for prescription painkillers," the release said.

Stumbo, who preceded Conway as attorney general, said in the release, “Given the true epidemic we are seeing, we cannot afford to wait another year to try to pass this again.” In October, Stumbo, Beshear and Conway "announced creation of an advisory board of physicians, dentists, nurses, and pharmacists to work with KASPER officials and law enforcement professionals to create guidelines for generally accepted prescribing practices among different medical disciplines," the release said. "These criteria will be used as a guide for when a prescriber or dispenser’s KASPER reports may be flagged for unusual prescribing activity."

The bill would require all prescription providers to register and use KASPER, require pain management clinics to be owned by a licensed medical practitioner, make medical licensure boards investigate prescribing complaints within four months. 

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

By Ivy Brashear
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

No good alternative to prescribing painkillers

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

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

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

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

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

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

“Unfortunately, in my patients I wanted to say, ‘Yes, let’s treat your pain and you won’t feel any good effects’,” Lofwall said. “I wasn’t able to say that to them.” She said they are now trying to help doctors better prescribe pain medication so that habits aren’t formed.

One of the biggest habit-forming painkillers is Oxycontin, which was introduced in 1996 but wasn’t abused on a large scale until doctors had to start documenting pain in 1999, Lofwall said. Sales of, treatment for, and death from prescription drug abuse have increased since then. She noted that Kentucky has the highest rates of opioid use and overdose.

The makers of Oxycontin have reformulated the drug to make it harder to crush, mix with water and snort, but a new drug has risen to take its place: Opana. Lofwall said researchers have been trying to study Opana use, but can’t get a study supply because it is in such high demand. She said she has seen more of a rise in heroin use by her patients because even heroin is easier to get than Opana.

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

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

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

Meds-for-meth, pain-pill bills each clear a second chamber; both probably headed to conference committee(s)

"State lawmakers gave new life Wednesday to two bills designed to tackle Kentucky's problems with methamphetamine labs and prescription drug abuse," John Cheves and Jack Brammer report for the Lexington Herald-Leader.

"On a 60-36 vote, the House approved Senate Bill 3, which would further limit the amount of cold medicines containing pseudoephedrine that consumers could buy without a prescription. Pseudoephedrine is a key ingredient used in making meth. Meanwhile, the Senate approved House Bill 4, which transfers from the state Cabinet for Health and Family Services to the attorney general's office an electronic monitoring system that keeps track of prescriptions for pain pills. The vote was 26-9. Both bills are likely to go to conference committees made up of representatives from both chambers, who will try to negotiate a compromise on differences in the House and Senate versions of the bills." (Read more)

Senate panel OKs pill-mill bill with provision moving prescription-monitoring system to attorney general's office

Over the objections of the Kentucky Medical Association, a Senate committee today approved a bill that would "transfer oversight of the state’s prescription-monitoring system from the Cabinet for Health and Family Services to the attorney general’s office," Jack Brammer reports for the Lexington Herald-Leader.

House Bill 4, an effort to fight so-called "pill mills," passed the Senate Judiciary Committee 7-2 after Chairman Tom Jensen, R-London, said last week that he trusted the attorney general's office to handle the job, now in the hands of the Kentucky Board of Medical Licensure. The bill now goes to the Senate Rules Committee, which could send it to the floor or to another committee, a move that would probably kill it since this is the last week of the legislative session.

The bill would allow no more than 20 attorney-general employees to access the monitoring system. It would also require doctors to report pain-pill prescriptions within 24 hours starting July 1, 2013, and would "not charge health care providers a fee for using the system," Brammer reports. The committee also changed the bill to allows only physicians to own pain-management clinics. (Read more)

Board suspends license of doctor at raided Lexington pain clinic

DEA agent enters building housing clinic
(Herald-Leader photo by Charles Bertram)

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

The Kentucky Board of Medical Licensure imposed an emergency suspension yesterday on the license of the doctor at a Lexington pain clinic that was raided by the Drug Enforcement Administration on Wednesday.

Dr. Najam Azmat "had little formal training in pain management or primary care, yet he was paid $7,500 a week to write prescriptions for powerful narcotic painkillers" at Lexington Algiatry, a pain clinic on Alexandria Drive, the Lexington Herald-Leader reports, drawing on board documents. The board's order said, "Azmat organized his practice at the Lexington Algiatry Clinic to maximize fraud and abuse, and it appears to be intentional."

The board "acted on an investigation that's been going on for some time," President Preston Nunnelley told the Herald-Leader. Azmat referred the newspaper to his lawyer, Fox DeMoisey of Louisville, who said he could not respond because he had not seen the board's allegations or the DEA's search warrant. "He intends to defend the matter vigorously," DeMoisey told the paper.

Azmat told a board investigator that he was employed by Warren Gold of Tampa, Fla., who owns Lexington Algiatry, for $7,500 a week. Valarie Honeycutt Spears and Josh Kegley of the Herald-Leader report, "Gold provided him with an apartment in Lexington, and Azmat traveled between Lexington and Georgia, where his family lives, organizing his work schedule around his flight schedule, the documents said." (Read more)

UPDATE, Feb. 18: A representative of the clinic "filed to do business under a new name," Kegley reports.

His latest story has more background on Gold, left, who pleaded no contest in Tampa to operating a pain clinic without a license, which at the time (2010) was required only by a local ordinance. His probation ended Dec. 23. He does not have a medical license in Florida or Kentucky, Kegley reports.

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storyli

2 out of 3 Kentuckians disposing of prescription drugs improperly, poll finds

By Tara Kaprowy
Kentucky Health News

At a summit on prescription drug abuse last week, Attorney General Jack Conway spoke of experiences he's had talking to middle schoolers about prescription drugs. When he asks if they know someone who has tried drugs that haven't been prescribed to them, 70 to 80 percent of hands go up. But when asked to keep their hands up if their parents keep their medicine cabinets locked, "all hands go down," Conway said. "This is a problem that is starting in our homes," he said. "It's a culture we have to break."

Not only are most medicine cabinets not locked, they are usually not cleaned out in the proper way, according to the latest Kentucky Health Issues Poll. Sixty-five percent of Kentucky adults dispose of prescription drugs by throwing them away (37 percent) or flushing them down the drain (28 percent). Only 6 percent take them to a recycling center and just 4 percent take them to a government or police facility where they can be safety discarded — though those are the two methods of disposal recommended by the Food and Drug Administration.

The drugs that are thrown in the garbage or flushed down the drain eventually reach the water supply, posing potential harm to people and wildlife. In a 2008 inquiry, The Associated Press found trace amounts of antibiotics, anti-convulsants, mood stabilizers and sex hormones in the drinking water of 24 major U.S. metropolitan areas, including Louisville. Though the concentrations were tiny, "the presence of so many prescription drugs — and over-the-counter medicines like acetaminophen and ibuprofen — in so much of our drinking water is heightening worries among scientists of long-term consequences of human health," AP reported.

The Health Issues Poll found that nearly 50 percent of respondents aged 18-29 threw unused or expired prescriptions in the trash. That percentage steadily decreases as people get older, with just 23 percent of people 65 and older likewise trashing the drugs, though they were more likely to flush them down the drain (33 percent). Education levels do not seem to be a factor.

The FDA recommends disposal through take-back programs, which offer locations for people to bring unused or expired drugs. The next National Drug Take Back Day will be April 28. On the last Take Back Day, 377,086 pounds of unwanted or expired drugs were turned in. Also, Kentucky has 76 drop boxes in 46 counties (yellow on map; counties with pending sites in blue) where people can dispose of drugs. To find a listing of these drop box locations, click here.

The poll was funded by The Health Foundation of Greater Cincinnati and the Foundation for a Healthy Kentucky. It was conducted Sept. 27 to Oct. 27 by the Institute for Policy Research at the University of Cincinnati. A random sample of adults across Kentucky were interviewed, including 1,313 landline interviews and 308 cell-phone interviews. For more information about the findings, click here.

Kentucky center helps more than 1,000 providers get electronic health records

The Kentucky Regional Extension Center has helped more than 1,000 health care providers transition to electronic health records, with specialists advising providers so they can meet the federal standards of "Meaningful Use."

"Quick access to electronic health records can make the difference in a provider's ability to treat the patient, whether it means checking a patient's cholesterol during a routine examination or identifying a medication allergy during an emergency," said Dr. Carol Steltenkamp, who directs the KY-REC and is the chief medical officer and pediatrician at UK HealthCare.

The adoption of EHRs by providers doubled from 17 percent in 2008 to 34 percent in 2011, the National Center for Health Statistics reports. As of Nov. 30, 2011, the Centers for Medicare and Medicaid Services had paid out more than $920 million in Medicare EHR incentives and $916 in Medicaid incentives, UKNow reports. The use of electronic prescribing, which allows physicians to generate, transmit and file patient prescriptions, has increased from 0.8 percent in December 2006 to 40.2 percent in September 2011, the nation's largest e-prescribing network Surescripts reports. (Read more)

Pure hydrocodone pain pill in testing; critics worry about abuse

A new pain pill, one more powerful than OxyContin and 10 times stronger than Vicodin, is being tested on patients by four drug companies and could be out as early as 2013. The new medicine, which is a pure form of hydrocodone, has law enforcement in Eastern Kentucky worried, reports Ralph B. Davis of the Floyd County Times.

"In my personal opinion, a drug like that shouldn't be a prescription medication," Floyd County Coroner Greg Nelson told the Times. "It should strictly be an in-house medication."

Drug maker Zogenix of San Diego plans to apply early next year to begin marketing Zohydro, a time-released drug intended to manage moderate to severe pain, reports Chris Hawley of The Associated Press. The drug has completed three rounds of testing.

Critics worry abusers will simply crush the pill to get an intense, immediate high. "I have a big concern that this could be the next OxyContin," said April Rovero, president of the National Coalition Against Prescription Drug Abuse.

The companies defend the drug by saying pure hydrocodone "would avoid liver problems linked to high doses of acetaminophen, an ingredient in products like Vicodin," Hawley reports. "They also say patients will be more closely supervised because, by law, they will have to return to their doctors each time they need more pills."

But critics remain unconvinced and are worried about the larger ramifications of the pills being on the market. "Hydrocodone abuse is already a tremendous problem in Southern and Eastern Kentucky," Karen Kelly, executive director of the government-funded anti-drug program UNITE, told Davis. "When used properly, these medications help many who are experiencing moderate to severe pain. Unfortunately, we have seen how easily the system can be abused."

Davis expressed his own views in an editorial that ran earlier this week. "The pharmaceutical companies developing Zohydro and other copycat drugs clearly must know that their products will kill people," he wrote. "They see it happening every single day. And they have been warned that the problem is growing worse."

Davis referred to a report by the Centers for Disease Control and Prevention, which found that in 2008, an average of 40 people a day in the United States died as a result of prescription painkiller overdoses, a 400 percent increase over 10 years. "Meanwhile, the pharmaceutical companies raked in billions in profits, and financial speculators are taking note," Davis writes. "Since stories about concerns over Zohydro first began appearing over the weekend, Zogenix's stock has skyrocketing nearly 70 percent ... To put it bluntly, this is horrifying." (Read more)

Johnson County focus of C-J series on docs, prescription abuse

The second day of The Courier-Journal's investigation into prescription drug abuse and the role of doctors looks at Johnson County, ranked 11th in the state for drug overdose deaths despite its small population of 24,000. It ranks second in such deaths per capita, right behind adjoining Floyd County, as shown on this C-J map of death rates by county. (Click on map for larger version.)

In Paintsville, Johnson's county seat, three doctors have been convicted in the past 10 years of prescribing narcotics illegally. The epidemic prompted the county Fiscal Court to try to pass an ordinance that would have outlawed clinics that were "dealing largely in cash; drawing significant numbers of patients from other counties; generating at least half of their revenue from prescribing narcotics; dispensing disproportionate amount of prescriptions, compared with other medical services; and not being affiliated with a nearby hospital," R.G. Dunlop reports. Attorney General Jack Conway's office ruled the county did not have the authority to pass such a ban.

Dunlop relays the stories of the Paintsville doctors with shocking prescribing practices and also speaks to the mayor, who called the problem "an epidemic." "What we end up doing is arresting all these 'victims' ... and the doctors who create the problem continue to practice." The C-J site also includes this video of Dunlop and photographer Scott Utterback's encounter with Aaron Cantrell, a co-owner of a clinic that is pictured today and will be the focus of more coverage tomorrow. (Read more)

Kentucky second highest in antibiotic consumption in U.S.

The next time you ask your doctor for an antibiotic, or if he or she offers to give you one, think again. It might do your health no good, but could be bad for public health.

"Every time an antibiotic is used ... future effectiveness of that drug is diminished," but Kentuckians take antibiotics at the second highest rate in the country, with 1,205 prescriptions per 1,000 people, says a study by the Centers for Disease Dynamics, Economics and Policy. Only West Virginia had a higher rate, 1,214 per 1,000. 

Studies show 1 million antibiotics are prescribed unnecessarily every year. "Though antibiotics offer no benefits for colds and other viral infections, many people, including doctors, continue to view these drugs as a quick fix," said a press release by the Robert Wood Johnson Foundation, which helped fund the study.

The problem with the overuse of antibiotics is that bacterial infections become resistant to them. To illustrate the issue, CDDEP says, "High-level penicillin resistance in Streptococcus pneumonia in the United States has experienced a thousand-fold increase in the last 20 years," rising from 0.02 percent in 1987 to more than 20 percent in 2004. The prevalence of methicillin-resistant Staphylococcus aureus — known more commonly as staph — increased from about 2 percent in 1974 to 50 percent in many U.S. hospitals in 2004.

"The problem of resistance is an evolutionary game played between humans and microbes: we try to stay ahead by creating new antibiotics, and microbes develop resistance to our drugs," CDDEP reports. "Unfortunately for us, microbes evolve resistance to antibiotics faster than we can create new drugs, meaning that, in recent years, bacteria have been winning this 'arms race.'"

Though there is no cure to resistance, managing the levels at which people become resistant is possible through judicious prescribing, vaccination, hospital infection control, treatment strategies and new antibiotics. (Read more)

Former official: DEA failed to slow prescription drug abuse epidemic by not limiting production

At a time when Oxycontin abuse was rapidly increasing, the Drug Enforcement Agency had the power to slow production of the drug and perhaps stave off what is now a prescription drug abuse epidemic in rural areas across the country, reports Guy Taylor of Salon. However, the agency allowed production of Oxycodone, the non-generic form of Oxycontin, to increase by 1,200 percent over a decade.

After the Food and Drug Administration approves a drug for production and sale, a section of the DEA known as the Office of Diversion Control decides how much of a drug can be manufactured. By law, the makers of Oxycodone and its generic forms have to present a quota approval application to Diversion Control. The office decides whether the amount requested can be manufactured. With the help of statistics provided by a former head of Diversion Control, Gene Haislip, Taylor discovered that in 1997 when Purdue Pharma first introduced Oxycontin, it was allowed to make 8.3 tons. This year, the DEA approved the manufacture of 105 tons.

Haislip tells Taylor DEA approved the increase in production in the face of a growing drug abuse epidemic, showing a "serious lack of accountability and oversight." Says Haislip: "The DEA is the lone federal agency with the power to decide how much of the drug gets made and put out there; it alone has had all the responsibility to do something about this problem." He told Taylor the agency should have learned from two examples in the 1970s and 1980s, when Diversion Control reduced quota requests for pill-based amphetamines and Methaqualone, the main ingredient in Quaaludes. When the quotas were reduced, illicit use of those drugs significantly decreased.

Asked why the agency allowed the production quota of Oxycodone to increase so much, DEA supervisory special agent Gary Boggs told Taylor the agency is required to set quotas at a level that "ensures an uninterrupted supply for the legitimate medical and scientific research needs of the United States, and that those needs are always changing as the population grows and as medical science finds different needs for products." He said there are patients who need the drug for medical purposes and the agency cannot limit their access because of those who abuse it.

Taylor opines: "The fact is that the U.S. government has adopted a position on prescription painkillers that differs from its policy toward other controlled substances such as cocaine, heroin and marijuana: Unlike those drugs, the DEA says limiting the supply of the prescription painkillers will not reduce abuse." He reports the agency's lack of oversight in the production of Oxycodone is "perplexing" to state and local governments now battling prescription pill abuse crises in their areas. Ohio Department of Alcohol and Drug Addiction Services director Orman Hall told Taylor the "the loss of life and the carnage associated" with prescription drug abuse could have been prevented had the DEA limited the production of Oxycodone. (Read more)