Half again as many Kentucky newborns were hospitalized for drug dependency last year as the year before

Mother Samantha Adams and her newborn Leopoldo Bautista,
10 days old, spend quality time inside the Louisville Norton
Healthcare child care center for children experiencing drug
withdrawal. (Photo by Alton Strupp, The Courier-Journal)

Increasing drug abuse drove up hospitalizations of drug-dependent newborns in Kentucky by 48 percent last year, to 1,409 from 955 in 2013. "The latest numbers represent a 50-fold increase from only 28 hospitalizations in 2000," reports Laura Ungar of The Courier-Journal.

"The seemingly never-ending increase every year is so frustrating to see," Van Ingram, executive director of the state Office of Drug Control Policy, told Ungar. "It's a horrible thing to spend the first days of your life in agony."

"These infants are born into suffering," Ungar writes. "They cry piercingly and often. They suffer vomiting, diarrhea, feeding difficulties, low-grade fevers, seizures — and even respiratory distress if they're born prematurely."

Drug-dependent newborns are becoming more common nationwide, Ungar notes, but "Vanderbilt University researchers publishing in the Journal of Perinatology [a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies] say rates are highest in a region encompassing Tennessee, Mississippi, Alabama and Kentucky."

While the increase is blamed mostly on illegal drug use, the Vanderbilt study found that 28 percent of pregnant Medicaid recipients in Tennessee filled at least one painkiller prescription, Ungar writes: "Legitimate use not only raises the risk of having a drug-dependent baby, it can sometimes lead to abuse and addiction."

While Medicaid now pays for behavioral-health and substance-abuse treatment, "Drug treatment for pregnant women is sorely lacking," Ungar reports. In Kentucky, only 71 of the 286 treatment facilities listed by the U.S. Substance Abuse and Mental Health Services Administration treat pregnant women. 

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

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."

Paducah Sun looks at two local doctors who write many prescriptions for painkillers; such local data are easily available

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.

Chiropractors cite research recommending 'conservative treatments' for low-back pain before prescribing painkillers

Recent research has questioned the effectiveness of acetaminophen for the treatment of spinal pain. In response, the American Chiropractic Association recommends that patients and health-care providers take a conservative approach to back pain. According to a study published in the British Medical Journal, the commonly administered painkiller isn't helpful for diminishing low-back pain.

According to a report released by the federal Centers for Disease Control and Prevention, Kentucky ranks among the top five states for opiate painkiller prescriptions written per 100 people, Deborah Highland reports for the Bowling Green Daily News.

"Research supports the use of more conservative treatments as a first-line defense against pain," said ACA President Anthony Hamm. "This sensible approach not only reduces healthcare costs but may also help some patients avoid riskier treatments altogether," he said in a news release that has exercise tips, posture recommendations and injury prevention techniques to help people maintain healthy backs throughout life.

Pain and fever reducer acetaminophen, most-used drug in U.S., is found to reduce positive emotions and reduce psychological pain

Ohio State University researchers discovered a new side effect of acetaminophen, a leading over-the-counter pain reliever: it also blunts positive emotions. Other research revealed that it helps reduce psychological pain. The drug has been used in the U.S. for more than 70 years and is best known by the brand name Tylenol.

In the Ohio study, participants took Tylenol or a placebo, then looked at very pleasant or very disturbing photos. Those in the experimental group reported weaker emotions than those in the control group. On average, those who took the placebo rated their level of emotion when viewing the photos at 6.76 on a scale of 10, while people who took the pain reliever averaged 5.85.

"Rather than just being a pain reliever, acetaminophen can be seen as an all-purpose emotion reliever," said Geoffrey Durso, the lead author of the study and a doctoral student in social psychology.

Balwin Way, an assistant psychology professor who conducted the study with Durso, said those who took Tylenol didn't seem to be aware they were reacting differently. "Most people probably aren't aware of how their emotions may be impacted when they take acetaminophen," he said.

Acetaminophen, found in more than 600 medicines, is the most common drug in the U.S., according to the Consumer Healthcare Products Association. Every week approximately 52 million American adults, 23 percent of the population, use a medicine with acetaminophen in it. Durso said researchers don't know if other pain relievers like ibuprofen and aspirin have similar effects, but they plan to study that question.

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.

UK headache clinic among top 20, and affiliated orofacial pain program is only one in Midwest or South; they give relief

Headache sufferers often struggle with finding the right treatment, and some even find themselves on medications that don't work and become completely unable to function. One of those found relief at the headache clinic at the University of Kentucky.

Tonya Morgan, a 30-year-old chemist, got a debilitating migraine headache that wouldn't go away in 2011. Before she connected with the UK clinic, she had seen many doctors and was taking as many as 30 different types of medicine a day to no avail, and had been given a recommendation from the Cleveland Clinic after an 11-week evaluation, for "extremely risky brain surgery," says a UK news release. "I was so sensitive to noise that I could lie in my bed and hear my mother down the hall eating potato chips. Going to a restaurant, driving, going to church -- all of those became unbearable. I was miserable," Morgan said.

Her doctor is Dr. Siddharth Kapoor, director of the Headache Clinic at the Kentucky Neuroscience Institute at UK HealthCare. He and Dr. Jonathan Smith are part of the headache program at UK that is considered among the top 20 accredited programs in the country, according to the release. It uses a multidisciplinary approach; UK HealthCare's orofacial pain program, which complements the services of the headache clinic, is one of just 12 accredited programs nationally, and the only one in the entire Midwest and South.
Kapoor's strategy, says the release, includes spending enough time with the patient to find out as much as he can about their headaches and finding the most effective way to get rid of them. "Headache is an extremely complex neurological process, and there usually isn't a quick fix for pain relief," Kapoor said. "Unless you spend a lot of time with each patient, listening to their problems and asking a lot of questions, it's nearly impossible to find the right way to help them."

Kapoor tried several different treatments on Morgan before they found the most effective: radio-frequency ablation, during which a high-frequency electric current was targeted at specific nerves in the brain, destroying the tissue responsible for her headaches. She is now headache free and has resumed a "normal life," the release says.

Headaches and other chronic pain affect more than 36 million Americans, and many of them don't seek help -- or see doctors who aren't completely aware of the full range of pain management, according to the release. Smith said there are many myths surrounding headache causes, such as foods or changes in blood vessels in the brain, and the UK clinic can "attack headache on many fronts."