McConnell, Mass. Democrats find common ground on opioid-overdose epidemic; Kentucky ranks 3rd in overdose deaths

Republican U.S. Sen. Mitch McConnell and two Massachusetts Democrats have found common ground in efforts to fight the opioid-overdose crisis and are working across the aisle to push for legislation and information to address it, Asma Khalid reports for WBUR, a Boston NPR affiliate.

Sens. Ed Markey, D-Mass., and Mitch McConnell, R-Ky.,
agree on fighting the opoid overdose epidemic. (AP photos)

“McConnell and I are requesting that there be a surgeon general report on the opioid overdose epidemic in the United States,” Sen. Ed Markey told Khalid. Markey is also co-sponsoring a bill with Sen. Rand Paul, R-Ky., to expand the use of medication-assisted treatment, like Suboxone.

Kentucky has the third highest overdose death rate in the nation, with more than 1,000 people dying each year, according to the state attorney general's website. Massachusetts has the 32nd highest overdose death rate in the nation, according to Trust for America's Health. Most of these opioid deaths in both states are from prescription drugs.

“The reason I can do that with two senators from Kentucky, who are Republicans, is that there really is no difference between Lexington, Massachusetts, and Lexington, Kentucky,” Markey said. “We have an epidemic in both states, and we have to ensure that we put together a national plan.”

McConnell has also partnered with Rep. Katerine Clark, D-Mass,, on a bill that focuses on infants and neonatal abstinence syndrome. “Mitch McConnell and I may disagree on 98 percent of topics, but we agree on this,” Clark told Khalid.

Drug-dependent newborns in Kentucky increased by 48 percent last year, to 1,409 from 955 in 2013, which was up from only 28 in 2000, Laura Ungar reported for The Courier-Journal last week. "Research in the Journal of Perinatology shows opioid addiction in babies grew nearly five-fold between 2000 and 2012," Khalid notes.

The McConnell-Clark proposal "tries to pull the best practices from around the country to improve treatment and prevention for sick babies. The bill has 80 cosponsors so far, and they’re from both sides of the aisle," Khalid reports, with no opposition voiced at the House Committee Energy and Commerce last week.

Another Massachusetts Democrat on the committee said he supports the effort, but the key is money -- something McConnell has been stingy with, supporting automatic cuts to reduce the federal budget deficit.

“The big push that I’ve been trying to focus on in our hearings is this comes back to the lack of resources — lack of doctors, lack of treatment facilities, lack of beds, lack of continuum of care,” said Rep. Joe Kennedy III, D-Mass., “because our federal government has systematically underfunded resources for prevention and treatment.”

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.

Kentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011

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."

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)

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.

Ky. ranks 8th in the number of high-prescribing Medicare physicians for powerful narcotic painkillers and stimulants

Kentucky ranks eighth in Medicare physicians who are considered "high prescribers" of Schedule 2 medications, drugs that have the highest potential for abuse like oxycodone, fentanyl, morphine and Ritalin, according to an analysis of Medicare data analyzed by ProPublica, Laura Ungar reports for The Courier-Journal. About 1,000 Kentuckians die each year from drug overdoses.

Medicare's drug program, Part D, covers about 38 million seniors and disabled and pays for more than one of every four prescriptions dispensed in this country, Charles Ornstein and Ryann Grochowski Jones report for ProPublica, a non-profit investigative news organization.

Further analysis by The Courier-Journal found that Kentucky doctors prescribed narcotic painkillers to a "much larger percentage of their elderly and disabled patients" compared to other states, and that Kentucky had 11 of the 269 prescribers who wrote more than 3,000 prescriptions for Schedule II drugs under the program, Ungar reports.

"One in five doctors who wrote at least 3,000 prescriptions for Schedule 2 drugs have faced some kind of sanction or investigation, according to the ProPublica analysis," Ornstein and Jones write.

Kentucky's top prescribers, those with the largest numbers of Medicare patients who received at least one prescription for a narcotic painkiller in 2012, include three pain doctors, an adult-medicine physician and an internal-medicine doctor, Ungar reports.

In 2012, 12 of Medicare's top 20 prescribers of Schedule 2 drugs faced disciplinary actions by their state medical boards, Ornstein and Jones report. In Kentucky, only one of its top prescribers, Dr. Gregory Mick, a Lexington adult-medicine physician, has been disciplined by the Kentucky Board of Medical Licensure, which ordered him to stop prescribing controlled substances, Ungar reports.

The other four top prescribers told Ungar that "they are practicing good medicine and have legitimate reasons for having more than 1,000 Medicare patients each who received at least one narcotic painkiller prescription."

Beginning in mid-2015, Medicare will have the authority to kick doctors out of the program if they prescribe in abusive ways, Ornstein and Jones report. Medicare sent letters to 760 high prescribers in September "in hopes that they will examine their prescribing and make changes."

ProPublica obtained the data under the Freedom of Information Act to update its online Prescriber Checkup tool with the most recent numbers available and shared it with The Courier-Journal and other Gannett Co. news organizations. A Courier-Journal reporter further analyzed the information about Kentucky doctors.

Deaths from drug overdoses and prescriptions for opiate treatment drugs are both rising, worrying state officials

Despite measures to discourage prescription drug abuse, Kentucky health officials report overdose deaths continue to rise and opioid treatment drugs are being prescribed "at alarming rates," Kevin Wheatley reports for cn|2's "Pure Politics."

A shift to cheaper, readily available heroin is partly to blame, Audrey Haynes, secretary of the Cabinet for Health and Family Services, told the legislature's Interim Joint Committee on Health and Welfare Wednesday.

Haynes told the committee that heroin overdose deaths in Kentucky increased 207 percent from 42 in 2011 to 129 in 2012; Kentucky ranks highest in hospital admissions for heroin abuse among surrounding states and the national average; more women age 18-44 in Kentucky die from drug overdoses than the U.S. average; and the state has shown a 165 percent increase in neonatal abstinence syndrome in newborns from 2008 to 2013.

Another issue, Wheatley writes, is that opiate treatment drugs like buprenorphine, which can be prescribed by physicians, have been seized by police in arrests at higher rates, creating a concern among health officials that it is being used illegally.

The medical director of the Department for Medicaid Services, John Langefeld, told Wheately that data show a 241 percent increase in buprenorphine prescriptions for Medicaid recipients from January 2012 to this May and that police seizures of this drug have increased "threefold" since tougher laws on prescription drug abuse took effect in July 2012.

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)

Drug developed to treat addiction is being abused, so much that clinics have been opened to sell it

"Suboxone, a popular and highly touted medicine designed to get people off opioids such as painkillers and heroin, is increasingly being abused, sold on the streets and inappropriately prescribed, according to doctors and drug control and law enforcement officials," Laura Ungar reports for The Courier-Journal. "The drug combines buprenorphine, an opioid, and naloxone, which counters the effects of an overdose. Prescriptions for Suboxone and its generic equivalent rose 63 percent in Kentucky between the first quarter of 2012 and the first quarter of this year, to 113,713 from 69,640."

One reason is the state's crackdown on pain clinics that were little more than pill mills. "In lieu of that, now people are opening Suboxone clinics. Many are cash-only," Leanne Diakov, general counsel for the Kentucky Board of Medical Licensure, told Ungar. "We have seen some doctors in trouble with licenses or finances opening these clinics." Ungar found that 14 percent, or 45, of the 330 Kentucky physicians authorized to prescribe buprenorphine "have a history of discipline by the medical board."

Attorney General Jack Conway told Ungar that suboxone abuse "is certainly on my radar, but I've kind of been careful to tread lightly. Some people desperately need Suboxone. I view it as a treatment of last resort . . . not a magic pill for addiction." Doctors told Ungar that some addicts self-medicate with Suboxone and use it to stave off withdrawal symptoms "when they have nowhere else to turn," she writes.