Seniors get a lot of anti-anxiety drugs, sometimes in dangerous combination with narcotics; Ky. ranks third in the nation in that

When Medicare's drug program, called Part D, was put into place more than a decade ago, Congress decided to not pay for anti-anxiety medications. In 2013, when Medicare started paying for them, the program went from spending nothing for these medications to paying more than $377 million, Charles Ornstein and Ryann Grochowski Jones report for ProPublica, a nonprofit, investigative news organization.

Using anti-anxiety drugs in combination with narcotics increases the risk of overdoses, but Kentucky has many doctors who prescribe a lot of both. More than 100 Kentucky doctors each wrote at least 1,000 prescriptions for both types of drugs in 2013, according to data compiled by ProPublica.

That ranked Kentucky third in the nation, trailing only Florida and Alabama. Other southeastern states dominated the top 10. California, the nation's most populous state, ranked eighth; Tennessee was fourth and Ohio was ninth.

ProPublica has an application that lets you look up, by doctors' names, cities or ZIP codes, the number of Medicare claims they filed in 2013, the amount of money, the number of patients and the number of prescriptions for brand-name drugs.

The anti-anxiety drugs, some known as benzodiazepines, include popular tranquilizers such as Valium, Xanax and Ativan. 

Lawmakers initially chose to keep them out of Medicare Part D because they had been linked to abuse and an increased risk of falls among the elderly. Doctors kept prescribing them to Medicare enrollees, who found other ways to pay for them.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, ProPublica found. Generic versions of Xanax (alprazolam), Ativan (lorazepam) and Klonopin (clonazepam) were among the top 32 most-prescribed medications in Medicare Part D that year.

The American Geriatrics Society "discourages the use of benzodiazepines in seniors for agitation, insomnia or delirium because they can be habit-forming and disorienting and their effects last longer in older patients." The society does say the drugs "are appropriate to treat seizure disorders, severe anxiety, withdrawal and in end-of-life care," ProPublica notes.

One geriatric psychiatrist told ProPublica that the drugs are a "very real safety concern" for the elderly, and that he and others in his field don't use them as a "first-, second-, or third- line of treatment." Some geriatric psychiatrists have voiced concerns that these drugs are now being used instead of antipsychotics, since Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of their risks.

Several doctors who rank among Medicare's top prescribers of the drugs told ProPublica that any risks of anti-anxiety drugs are outweighed by their benefits. One said that the drugs worked well for his patients, many of whom were trying to kick addictions to narcotics, but struggled with anxiety and depression.

However, ProPublica also found that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, which increased the risk of misuse and overdose. That's where Kentucky ranked third.

Dr. Leonard J. Paulozzi, a medical epidemiologist at the federal Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010, ProPublica reports.

Polling shows Kentucky ranks third in share of residents, 24.5 percent, who say they take mood-altering drugs every day

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)

New health-related laws deal with heroin, dating violence, end-of-life care, prescriptions, colon-cancer and newborn screening

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The Kentucky General Assembly passed several health-related bills this session, including high-profile measures on heroin and dating violence. It did not pass many others, including one that would have a great influence on the state's health: a statewide smoking ban, which passed the House for the first time ever, but never got out of an unfavorable committee in the Senate. Here's a roundup:

Heroin: Kentucky's heroin-overdose epidemic was caused partly by a 2012 legislative crackdown on prescription painkillers, which steered users to the illegal drug. Last year's bill died because of deadlock over sentences for traffickers and needle-exchange programs for addicts, and Gov. Steve Beshear and legislators gave this year's bill top priority. It was not finally negotiated until a few hours before passage, but Beshear signed Senate Bill 192 into law less than 12 hours after it passed so that its emergency clause could put it into effect immediately.

SB 192 includes both a needle-exchange program and harsher penalties against traffickers, the main points of contention between the House and Senate, but requires local governments to approve needle exchanges and allows judges to be lenient in sentencing addicts, to help them get treatment. It allocates money for drug-treatment programs, allows increased access to Naloxone, a drug that reverses the effects of an overdose, and allows jailers to provide medically assisted treatment for inmates with opiate addiction.

Dating violence: After 10 years of lobbying and debate, the dating violence bill will allow dating partners to get interpersonal protective orders from a judge if they have been the victim of dating violence, sexual abuse or stalking. This year's bill largely dissolved social conservatives' opposition by creating a new chapter in the law for dating violence, with the same protections as the domestic-violence law. Kentucky is the last state to offer protection to dating-violence victims. House Bill 8 was sponsored by Rep. John Tilley, D-Hopkinsville, who also sponsored the House heroin bill.

Beshear has signed these bills into law:

Prescription synchronization: SB 44, sponsored by Sen. Julie Raque Adams,R -Louisville, will allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

Medical order scope of treatment: SB 77, sponsored by Sen. Tom Buford, R-Nicholasville. will create a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care.

Colorectal cancer screening: SB 61, sponsored by Sen. Ralph Alvarado, R-Winchester, will require that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The governor also signed a similar measure, HB 69, sponsored by Rep. Tom Burch, D-Louisville, which contains an amendment by Sen. Julian Carroll, D-Frankfort, for a Medicaid savings study.

Newborn screenings for fatal disease: SB 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, will require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur.

Spina bifida: SB 159, sponsored by Adams, will require medical providers to supply written, up-to-date, accurate information to parents when their unborn child is diagnosed with spina bifida so they can make informed decisions on treatment.

Emergency care for strokes: SB 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, requires that local emergency services have access to a list of stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky. Emergency medical providers will set their own protocols for assessment, treatment and transport of stroke patients.

Alcohol and drug counselors: HB 92, sponsored by Rep. Leslie Combs, D-Pikeville, creates an enhanced licensing program to recognize three levels of certified alcohol and drug counselors, with different levels of education. The goal is to increase the number of counselors in the state.

UK cancer research center: HB 298, sponsored by Rep. Rick Rand, D-Bedford, revises the state budget to authorize $132.5 million, half of the cost, for a new medical research center at the University of Kentucky. The university says it will raise money to cover the other half.

These health bills awaited the governor's signature Monday morning:

Physician assistants: HB 258, sponsored by Rep. Denver Butler, D-Louisville, to allow physicians to supervise up to four physicians at the same time, rather than two.

In-home care: HB 144, sponsored by Burch, to establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services.

Pharmacist-practitioner collaboration: HB 377, sponsored by Rep. Dean Schamore, D-Hardinsburg, to allow collaboration between pharmacist and practitioners to manage patients' drug-related health needs.

Tax refund donations: SB 82, sponsored by Sen. Max Wise, R-Campbellsville, to put an income tax check-off box on tax forms to allow people the option of donating a portion of their tax refund to support pediatric cancer research, rape crisis centers or the Special Olympics.

Health related bills that were left hanging:

The smoking ban, HB 145, sponsored by Rep. Susan Westrom, D-Lexington, never got a hearing in the Senate Veterans, Military Affairs and Public Protection Committee, and neither did the Senate companion bill, SB 189, sponsored by Adams.

Three bills challenged Medicaid managed-care companies. SB 120, sponsored by Alvarado, would have created a process for health-care providers to appeal the companies' decisions to the state passed the Senate, but not the House.  And the following two bills that never got out of the Senate: SB 88, also sponsored by Alvarado, which challenged the $50 "triage fees" MCOs pay for emergency-room visits that they conclude were not emergencies, and would have required them to pay contracted fees instead and SB 31, sponsored by Buford, which would limited the amount of co-payments. Also not getting House action was Alvarado's SB 6 would have created review panels for lawsuits seeking damages from health-care providers.

Poll shows more issues with heroin, fewer with pain pills

The latest Kentucky Health Issues Poll backs up law-enforcement opinion that Kentucky's metropolitan areas are experiencing increased problems with heroin use as misuse of prescription pain relievers such as OxyContin, Vicodin, Percocet and codeine is declining.

The poll found 11 percent of Kentucky adults reported having family and friends who have had issues with heroin, up from 9 percent in 2013. Regionally, the figures were 26 percent in Northern Kentucky; 13 percent in the Louisville area; 11 percent in the Lexington area; 8 percent in Eastern Kentucky and 7 percent in Western Kentucky.

Meanwhile, Twenty-four percent of Kentuckians reported knowing a family member of friend who had problems as a result of prescription pain reliever abuse, down from 32 percent in 2011. The margin of error for the poll of 1,597 randomly selected adults is plus or minus 2.5 percentage points, applicable to each number.

People from 18 to 29 are most likely to have a friend or family member who has experienced problems related to drug use, according to a release from the Foundation for a Healthy Kentucky, which co-sponsors the survey.

"Kentucky ranks fifth in the nation for drug overdose deaths, behind only West Virginia, Nevada, Utah and New Mexico," the release said. "Drug overdose deaths per capita have quadrupled since 1999, surpassing motor vehicle accidents as the leading cause of accidental death in Kentucky."

The poll was conducted between Oct. 8 and Nov. 6 by the Institute for Policy Research at the University of Cincinnati.

Kentucky doctors treat an increasing number of babies suffering from drug addiction given to them by their mothers

Neonatal abstinence syndrome, or NAS, is becoming such a widespread problem that many medical professionals are calling it an epidemic and a public-health crisis. In 2001, 67 Kentucky babies were hospitalized for drug withdrawal, and in 2013, 955 were, according to the Cabinet for Health and Family Services, Justin Madden writes for The Lexington Herald-Leader.

Baby Sheena, who has neonatal abstinence syndrome, in

treatment at the University of Kentucky Children's Hospital.

(Lexington Herald-Leader photo by Mark Cornelison)

Henrietta Bada, a neonatologist at the University of Kentucky Children's Hospital, said babies born with NAS are eager to eat, "but then you give them their formula or their feedings, but they just cannot." She said they can't "coordinate their suck-swallow reflexes . . . If they are not treated, then they end up with weight loss, dehydration," and are sicker than if they had only been going through withdrawal.

Bada said she can treat the babies with medication, but she wants to make sure they go to a safe home: "Babies have to go home to a mother that is capable of taking care of him or her." There isn't enough care for mothers dealing with drug addictions, she said, "and the lack of care continues after the baby is born." She also noted that at least 80 percent of the medical bills are paid through Medicaid, "which can cost as much as $60,000."

The Kentucky Perinatal Association and the state's Department for Public Health are working together to make standardized treatments for mothers and babies, The Associated Press reported earlier this month. Officials also continue to look for ways to solve the state's drug problem.

Eric Reynolds, a neonatologist at Kosair Children's Hospital in Louisville, pointed out that NAS isn't always a result of a mother abusing drugs. "We need better treatment options for the pregnant mothers who have a legitimate medical reason to be on these types of medications," he said.

Reynolds and Bada said endeavors to fight NAS begin with education, and Reynolds added that the long term effects of NAS are not yet known because it's early in the epidemic, Madden writes.

Former pharmacist and county commissioner discusses his battle with addiction with Hopkinsville newspaper

Jeremy Bowles, a former pharmacist and county commissioner in Montgomery County, Tennessee, was convicted of drug and forgery charges, and now he's discussing his experience to help others find freedom from their addictions, Steve Breen writes for Kentucky New Era in Hopkinsville.

"I want to be a message-bearer," Bowles said. Addiction "happened to me as it happens to a lot of people, and people deserve a second chance." While Bowles worked as a pharmacist at Jennie Stuart Medical Center in Hopkinsville, his addiction got so bad that he took blank prescription pads and forged doctor's signatures and cashed them at two different pharmacies. The police caught him when he attempted to use a fake paper at a Walgreens pharmacy in Clarksville.

"He was later indicted in Tennessee on four counts of obtaining a controlled substance by forgery and one count of identity theft," Breen reports. "In Kentucky, Bowles was indicted on nine counts of theft of a prescription blank, three counts criminal possession of a forged prescription, theft of a controlled substance and first-degree promotion of contraband."

Bowles was required to pay $754 in restitution, sentenced to five years of pretrial diversion and given 60 days in jail. However, the jail time may be exchanged for community service. During the sentence, he is not allowed to practice pharmacy in Kentucky.

Bowles said his downhill slide began after he was robbed at gunpoint in 2009 while working at a Clarksville pharmacy and he had to take anti-anxiety medication following the incident. "It became a crutch down the road," he said. "You start out with something prescribed, and it helps you, and you want to keep using it, and it just snowballed from there."

After he was arrested in Tennessee, Bowles went to a rehabilitaiton center in Knoxville for 120 days before going to the Christian County Jail to deal with his Kentucky charges, Breen writes. Bowles said he is glad his family and friends have helped him throughout the difficulties: "I've really changed my life 180 degrees. What I look for now in life is: God comes first, others second and myself third."

He will probably continue working his current job as a consultant for a media company until the suspension of his Tennessee license is lifted. Also he helps out in his 12-step recovery program by serving as a sponsor for two addicts. He said he doesn't have any plans to return to politics. (Read more; subscription required)

Kentucky ranks No. 4 in painkiller prescriptions; neighboring states are first, second and third

Powerful painkillers are a contributing factor in the the rising rate of overdose deaths in the U.S., especially in Kentucky, where officials have recommended more measures be taken to monitor painkiller prescriptions. Now the government is pointing out the states whose doctors write the most prescriptions, and Kentucky ranks fourth, Mike Stobbe reports for The Associated Press.

The reports are part of the federal Centers for Disease Control and Prevention's campaign to prevent deaths from prescription opioids such as Vicodin and OxyContin. Drug overdose deaths reached 41,000 in 2011, and 41 percent of them had to do with prescription painkillers. "The state account comes from a database of U.S. retail pharmacies that fill the bulk of prescriptions," Stobbe writes.

In 2012, Southern states led the list. Kentucky ranked behind Alabama, which had 143 prescriptions for every 100 people; Tennessee, and West Virginia. Southern doctors also prescribed the most antibiotics and stimulants for children. Although chronic disease rates are often higher in the South, research has shown that doesn't explain the disparity.

"Prescriptions go up; deaths go up. Prescriptions go down; deaths go down," said CDC director Dr. Tom Frieden. However, evidence to confirm the connection is lacking. The CDC keeps track of death rates but combines all drug overdoses, including heroin and cocaine. Those rankings are not the same as the prescription list. "But officials cite studies that show higher overdose rates when there are more prescriptions of painkillers and larger doses prescribed," Stobbe writes.

To help fix the problem, officials suggest more prescription drug monitoring programs at the state level and laws to stop "pill mills," which are offices and clinics that prescribe too many addictive medicines. In Florida, pill mills became a big issue in the last 10 years, but from 2010-2011, the state set up stricter pain clinic regulations, and police did some raids. "By 2012, prescriptions for oxycodone alone fell 24 percent, and the death rate for prescription drug overdoses dropped 23 percent," Stobbe writes. (Read more)