State judge dismisses constitutional challenge to anti-vaping law

By Sarah Ladd
Kentucky Lantern

Franklin Circuit Judge Thomas Wingate has dismissed a lawsuit challenging the constitutionality of a 2024 law banning the sale of some vaping products.

Wingate sided with the lawsuit’s defendants — Allyson Taylor, commissioner of the state Department of Alcoholic Beverage Control, and Secretary of State Michael Adams — who filed a motion to dismiss. The law designates the ABC as its enforcement agency.

The Kentucky Smoke Free Association, which represents vape retailers, had argued that the law was too broad and arbitrary to be constitutional because it is titled “An act relating to nicotine products” but also mentions “other substances.” The state constitution says a law cannot relate to more than one subject.

In his opinion, Wingate said the law doesn’t violate the state constitution.

The law’s title “more than furnishes a clue to its contents and provides a general idea of the bill’s contents,” he wrote.

The law’s “reference to ‘other substances’ is not used in a manner outside of the context of the bill, but rather to logically indicate what is unauthorized,” Wingate wrote.

The lawsuit centers on House Bill 11, which passed during the 2024 legislative session and is scheduled to take effect Jan. 1. Its backers said it will curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration.

Opponents have said it will hurt small businesses and favor big companies, and could drive youth to traditional cigarettes.

Altria, the parent company of tobacco giant Philip Morris, lobbied for the bill and is pushing similar bills in other states. Altria, which has moved aggressively into e-cigarette sales, markets multiple vaping products that have FDA approval.

“The sale of nicotine and vapor products are highly regulated in every state, and the court will not question the specific reasons for the General Assembly’s decision to regulate and limit the sale of nicotine and vapor products to only products approved by the FDA or granted a safe-harbor certification by the FDA,” Wingate wrote in a Monday opinion. “The regulation of these products directly relates to the health and safety of the commonwealth’s citizens, the power of which is vested by the Kentucky Constitution in the General Assembly.”

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UK expands heart and vascular care to hospitals across the state

By Melissa Patrick
Kentucky Health News

One of the many ways that UK HealthCare strives to improve the heart health of Kentuckians is through its Gill Heart and Vascular Institute Affiliate Network, which includes a community of hospitals across the state working to ensure patients receive high-quality cardiac care close to home. 

The program serves a great need, since heart disease is the leading cause of death in Kentucky and the state has one of the country’s highest rates of heart disease. 

Dr. Navin Rajagopalan

Dr. Navin Rajagopalan, director of the affiliate network, said it is made up of over 20 hospitals throughout the state.  

"Our key mantra is always . . . one of collaboration," he said. "The University of Kentucky is a big hospital, we have lots of services here. But we never want to be seen as competing with local, community hospitals for their patients. So we want patients to stay local for as long as possible to receive optimal cardiovascular care." 

He added that while it's important for UK's program to remain strong for patients who may need higher levels of care, the goal of the network is to "provide resources, education, and training, where appropriate, to the hospitals in our network." 

New to the network is Owensboro Health Muhlenberg Community Hospital in the Muhlenberg County seat of Greenville, featured recently in a UK news release. CEO Ed Heath said being in the network "furthers our mission to heal the sick and to improve the health of the communities we serve." 

“We look forward to utilizing the expertise of UK HealthCare and the perks of this affiliation to better serve our patients," he added.

Rajagopalan stressed that the program isn't about UK HealthCare taking over a hospital's cardiovascular program, but is designed to foster collaboration and expertise-sharing among the member hospitals. Members of the network have access to educational resources, quality improvement initiatives and specialized training. In addition, Rajagopalan said the network can provide outreach clinics or assist with cardiovascular imaging.

"The idea . . . is that patients can receive specialized care close to home," he said.

When Dr. MIchael Karpf was running UK HealthCare in 2013, he said it needed to expand its geographical reach to maintain its newly raised national status and to ensure access to quality care for Kentuckians. "We want the hospital to be the first choice when it comes to complex care,” he said, identifying several regional competitors. First on his list was Vanderbilt University in Nashville, which is 80 miles closer to the Greenville hospital than UK and gets many patients from Western and Southern Kentucky.

Asked if the program is driven by competition in any way, Rajagopalan said, "No, we make it very clear that this is not based on referrals." 

Rajagopalan said UK is not actively recruiting new hospitals into the network and that many of them in the network are ones that they already have a relationship with in some way. More often, he said, hospitals will call UK with a question about something and that's how they learn about the program. He added that UK HealthCare also offers the Markey Cancer Center Affiliate Network and a Stroke Care Network. 

As for money, he said that the fees collected within the affiliate network are put back into the program in some way. "We don't make any money off the network," he said. 

Hospitals in UK's Gill Heart and Vascular Institute Affiliate Network (UK HealthCare map)

According to the news release, the affiliate network includes 24 hospitals, more than 15 outreach locations and more than 12 sites where Gill provides cardiac image interpretation services across cardiovascular imaging modalities.

Rajagopalan told Kentucky Health News that the work they are doing at the Gill Heart and Vascular Institute Affiliate Network is "relatively unique." 

"We're kind of hoping to have more success stories and kind of share what we're doing to  other academic centers," he said. "Because I think the way that we, as an academic institution, interact with the community hospitals in our region is rather unique in terms of the spirit of collaboration and in trying to support all the hospitals  in the community."

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Messaging campaign to encourage back to school vaccines is underway; Kentucky vaccination rates are below U.S. average

Lexington-Fayette County Health Department graphic

By Melissa Patrick

Kentucky Health News

With just weeks left before school starts, it's time to make sure your school-aged children are up to date on required immunizations.  

Toward this effort, the Kentucky Association of Health Plans, the trade group for health insurers in the state, and Kentucky Voices for Health, a coalition of health advocacy groups, have partnered to roll out a messaging campaign to help educate families and improve student immunization rates. The partnership involves a 3-year, $360,000 grant from KAHP to be used toward building a stronger safety net in Kentucky.

"This back-to-school season is the perfect opportunity to talk to a provider and ensure that your family is caught up on recommended immunizations. If you or someone in your family has fallen behind, trust me, you are not alone," Kelly Taulbee, director of communications and development at KVH, said at a press conference to announce the partnership. " We encourage families today to work with providers and get the additional resources and an immunization schedule that's right for you and your children." 

Taulbee said the messaging campaign will involve TV commercials, radio ads and occasionally print. Asked if they would be targeting any certain region of the state, Taulbee said, " It's a relatively equal approach across the board as far as how we're messaging." 

Many Kentucky children are still catching up with routine vaccinations that were missed during the pandemic. The state's vaccination rates remain below the national average. 

"That puts our children at unnecessary risk and it strains our healthcare system," Tom  Stephens, president and CEO of KAHP, said at a press conference. 

Stephens noted that the recent outbreak of whooping cough in Lexington "underscored the urgency of this issue."  Last week, the state Department for Public Health reported 138 cases of whooping cough, known medically as pertussis, and said this level of infection had not been seen in Kentucky since 2016-17. 

"This outbreak is a stark reminder of what can happen when immunization rates fall," Stephens said. "It's not just about individual protection. It's about community immunity."

"Community immunity" occurs when enough people have been immunized against a disease to protect others who are not immunized. Some can't get vaccinations because their immune systems are too weak to allow them to get vaccinated, or because they are too young. 

Children can get their routine vaccinations at health clinics, health departments, pharmacies and doctor's offices, but it's important to make those appointments soon because school typically starts in August and students are required to provide up-to-date immunization records at the beginning of each school year, unless exempted for religious or medical reasons.

Taulbee noted that a law passed during the last legislative session allows pharmacists to continue administering immunizations down to the age of 5. "It's such a simpler access point that we want families to keep in mind," she said. 

Families can find a provider, including those that offer free immunizations through the Vaccines for Children program, by calling the Kentucky Infectious Disease & Vaccine Call Center at 855-598-2246, Monday-Friday, 8 a.m. to 5 p.m. 

Asked about vaccine hesitancy, which has been fueled by the Covid-19 vaccine, Taulbee and Stephens both encouraged families to talk to their provider if they have any questions or concerns about immunizations. 

A recent Pew Research Center survey of more than 10,000 adults found that 88% of Americans believe the overall benefits of the measles, mumps and rubella vaccine outweighs the risks, compared to 62% who believed the Covid-19 vaccine benefits outweigh the risks. Further, the survey found a drop in support for vaccine requirements for healthy children in schools, with 70% of those surveyed supporting the requirement, down from 82% in 2019 and 2016. 

Data from the School Immunizations Survey dashboard, which includes data for each school, show that during the 2023-24 school year, nearly 85% of kindergartners were up to date with all vaccines, 80% of seventh graders were, and nearly 54% of 11th graders were. 

The KAHP-KVH partnership will also focus on keeping children signed up for Medicaid as Medicaid renewals resume for them.  

"The renewal process is going to begin soon for the first time in four years for our children," Taulbee noted. "We encourage families to take this very seriously. Check your mail, watch and make sure you understand eligibility standards and keep your children covered." 

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Why millions are trying FDA-authorized alternatives to Big Pharma’s weight-loss drugs, exceedingly popular in Kentucky

Editor's note: Last year Kentucky led the nation in the percentage of population that had received these weight-loss druges by prescription.

By Arthur Allen

Britannica image

KFF Health News

Pharmacist Mark Mikhael has lost 50 pounds over the past 12 months. He no longer has diabetes and finds himself “at my ideal body weight,” with his cholesterol below 200 for the first time in 20 years. “I feel fantastic,” he said.

Like millions of others, Mikhael credits the new class of weight loss drugs. But he isn’t using brand-name Wegovy or Zepbound. Mikhael, CEO of Orlando, Florida-based Olympia Pharmaceuticals, has been getting by with his own supply: injecting himself with copies of the drugs formulated by his company.

He’s far from alone. Mikhael and other industry officials estimate that several large compounding pharmacies like his are provisioning up to 2 million American patients with regular doses of semaglutide, the scientific name for Novo Nordisk’s Wegovy, Ozempic, and Rybelsus formulations, or tirzepatide, the active ingredient in Eli Lilly’s Zepbound and Mounjaro.

The drug-making behemoths fiercely oppose that compounding business. Novo Nordisk and Lilly lump the compounders together with internet cowboys and unregulated medical spas peddling bogus semaglutide, and have high-powered legal teams trying to stop them. Novo Nordisk has filed at least 21 lawsuits nationwide against companies making purported copies of its drugs, said Brianna Kelley, a spokesperson for the company, and urges doctors to avoid them.

The U.S. Food and Drug Administration, too, has cautioned about the potential danger of the compounds, and leading obesity-medicine groups starkly warn patients against their use. But this isn’t an illegal black market, though it has shades of gray.

The FDA allows and even encourages compounding pharmacies to produce and sell copycats when a drug is in short supply, and the wildly popular GLP-1 drugs have enduring shortages — first reported in March 2022 for semaglutide and in December 2022 for tirzepatide. The drugs have registered unprecedented success in weight loss. They are also showing promise against heart, kidney, and liver diseases and are being tested against conditions as diverse as Alzheimer’s disease and drug addiction.

In recent years, the U.S. health-care system has come to depend on compounding pharmacies, many of which are run as nonprofits, to plug supply holes of crucial drugs like cancer medicines cisplatin, methotrexate, and 5-fluorouracil.

Most compounded drugs are old, cheap generics. Semaglutide and tirzepatide, on the other hand, are under patent, so they earn Novo Nordisk and Lilly billions of dollars a year. Sales of the diabetes and weight-loss drugs this year made Novo Nordisk Europe’s most valuable company and Lilly the world’s biggest pharmaceutical company.

While the companies can’t keep up with demand, they heatedly dispute the right of compounders to make and sell copies. Lilly spokesperson Kristiane Silva Bello said her company was “deeply concerned” about “serious health risks” from compounded drugs that “should not be on the market.”

Yet marketed they are. Even Hims & Hers Health — the telemedicine prescriber that got its start with erectile dysfunction drugs — is now peddling compounded semaglutide. It ran ads for the drugs during NBA playoff games. (According to a Hunterbrook Media report, Hims & Hers’ semaglutide supplier has faced legal scrutiny.)

The compounded forms are significantly cheaper than the branded drugs. Patients pay about $100 to $450 a month, compared with list prices of roughly $1,000 to $1,400 for Lilly and Novo Nordisk products.

Five compounders and distributors interviewed for this article said they conduct due diligence on every lot of semaglutide or tirzepatide they buy or produce, upholding standards of purity, sterility, and consistency similar to those practiced in the commercial drug industry. Compounders operate under strict federal and state standards, they noted.

However, the raw materials used in the compounded forms may differ from those produced for Novo Nordisk and Lilly, said GLP-1 co-inventor Jens Juul Holst, of the University of Copenhagen, adding that care must be taken in drug production lest it cause potentially harmful immune reactions.

To date, according to FDA spokespeople, reports of side effects from taking compounded versions haven’t raised major alarms. But everyone with knowledge of the industry, including the compounders themselves, worry that a single batch of a poorly made drug could kill or maim people and destroy confidence in their business.

“I liken the compounding industry to the airline industry,” Mikhael said. “When you have an airline crash, it hurts everybody.”

Warnings from the past

The industry endured just such a catastrophe in 2012, when the New England Compounding Center released a contaminated injectable steroid that killed at least 64 people and harmed hundreds more.

In response, Congress and the FDA had strengthened oversight. Mikhael’s company is an outsourcing facility, or 503B compounding pharmacy — so named for a section of the 2013 law that set new requirements for drug compounders. The companies are licensed to make slightly different versions of FDA-approved drugs in response to shortages or a patient’s special needs.

The law created two classes of compounding pharmacies: The FDA regulates the larger 503B compounders with standards like commercial drug companies, while 503A pharmacies make smaller lots of drugs and are largely overseen by state boards of pharmacy.

The 503A facilities also are producing compounded semaglutide and tirzepatide for hundreds of thousands of patients. Like the 503Bs, these operations take the active ingredient, produced as a powder in FDA-registered factories, mostly in China, then reconstitute it with sterile water and an antimicrobial in small glass vials.

Together, the compounding pharmacies may account for up to 30 percent of the semaglutide sold in the U.S., Mikhael said, although he cautions that is a “wild ballpark figure” since no one, including the FDA, is tracking sales in the industry.

The compounders say the companies should increase production if they’re worried about competition. Like the dozens of other drugs they produce for hospitals and medical practices, the compounders say, the two diet drugs are essential products.

“If you don’t want a 503B facility to make a copy, it’s pretty simple: Don’t go short,” said Lee Rosebush, chair of a trade association for 503B pharmacies. “FDA created this system because these are necessary drugs.”

Novo Nordisk hasn’t specified why it can’t keep up with demand, but the bottleneck apparently lies in the company’s inability to fill and sterilize enough of its special drug auto-injectors, said Evan Seigerman, a managing director at BMO Capital Markets.

The company announced June 24 that it was investing $4.1 billion in new production lines at its Clayton, N.C. site. The FDA last year issued a warning over procedural violations at the site and separate cautions at an Indiana facility that Novo Nordisk took over recently.

Compounding for dummies

At least 28 companies mostly in China, are registered with the FDA to produce or distribute semaglutide. At least half the companies have entered the market in the past 12 months, driving the raw material’s price down by 35%, according to Scott Welch, who runs a 503A pharmacy in Arlington, Va.

Compounders can buy powdered semaglutide from some U.S. distributors for less than $4,000 a gram, said Matthew Johnson, president and CEO of distributor Pharma Source Direct. That comes out to as little as $10 per weekly 2.5-microgram dose – not including overhead and other costs.

While Ozempic or Wegovy patients use a Novo Nordisk device to inject the drug, patients using compounded products draw them from a vial with a small needle, like the device diabetics use for insulin.

Some medical practices provide the compounded drug to patients as part of a weight loss package, with markups. Last July, Tabitha Ries, a single mother of six who works as a home health care aide in Garfield, Wash., found an online clinic that charged her $1,000 for three months of semaglutide along with counseling. She has lost 35 pounds.

She gets the drug from Mindful Weight Loss, a mostly telehealth-based operation led by physician Vivek Gupta of Manhattan Beach, Calif. Gupta said he’s prescribed the weight loss drugs to 1,500 patients, with about 60% using compounded versions from a 503A pharmacy.

He hasn’t seen any essential difference in patients using the branded and compounded forms, although “some people say the compounding is a little less effective,” Gupta said.

There’s some risk in using the non-FDA-approved product, he acknowledged, and he requires patients to sign an informed consent waiver.

“Nothing in life is without risk, but I would also argue that the status quo is not safe for people who need the medicine and can’t get it,” he said. “They’re constantly triggered by all this food that’s causing their weight to go up and their sugar to go high, increasing their insulin resistance and affecting their limbs and eyes.”

Compounding semaglutide is a helpful sideline for pharmacists like him, Welch said, especially given the pinch on drug sale revenue that has led many independents to close in recent years. He figures he earns 95% of his revenue from compounding drugs, rather than traditional prescriptions.

It’s important to distinguish compounded semaglutide from unregulated powders sold as “generic Ozempic” and the like, which may be contaminated or counterfeit, said FDA spokesperson Amanda Hils. But since compounded forms of the drug are not FDA-approved, those who make, prescribe, or use them also should have “an increased level of responsibility or awareness,” she said.

Corporate battles

Novo Nordisk and Lilly, in lawsuits each company has filed against competitors, say their own testing has found bacteria and other impurities in products made by compounding pharmacies. The companies also report patent infringement, but compounders, pointing to the FDA loophole for drugs in shortage, appear to have defeated that argument for now.

When the FDA removes the drugs from the shortage list, 503B compounders must immediately stop selling them. Smaller compounders may be able to produce their products for a reduced number of patients, said Scott Brunner, CEO of the Alliance for Pharmacy Compounding, which represents 503A compounders.

The evaporation of the compounded drug supply could come as a shock to patients.

“I dread it,” said David Wertheimer, an internist in Franklin Lakes, N.J., who prescribes compounded semaglutide to some patients. “People are not going to be able to plunk down a grand every month. A lot of people will go off the drug, and that’s a shame.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. 

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New health laws are in effect; one in limbo due to lack of funding

Kentucky Capitol (Wikipedia photo)

By Melissa Patrick
Kentucky Health News

A number of new state health laws took effect July 15, ranging from measures on maternal health to improved access to a commonly used allergy medication.

The General Assembly passed more than 200 bills during its 60-day session. They become law 90 days after adjournment of the legislature unless they have a defined effective date, are general appropriation bills, or are passed with an emergency clause. This year, the effective date was July 15.

Some of the health measures that are now law are:

Health Care Liability: House Bill 159, sponsored by Rep. Patrick Flannery, R-Olive Hill, protects health-care providers from criminal liability when a medical error harms a patient. The bill does not apply to harm resulting from gross negligence or wanton, willful, malicious or intentional misconduct.

Kratom: HB 293, sponsored by Rep. Kim Moser, R-Taylor Mill, aims to regulate kratom, an herbal drug frequently sold online and in convenience stores. The bill prohibits sales to people under 21 and provides guidelines for manufacturing and labeling the product.

This bill was included in a list of 22 laws mentioned in an April letter from Gov. Andy Beshear to legislators saying there is a lack of funding to implement them, so that puts this new law in limbo, Liam Niemeyer reports for the Kentucky Lantern.

Maternal health: Senate Bill 74, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, aims to support maternal and infant health and reduce the high mortality rate for mothers in Kentucky. Several sections of the bill took effect July 15, including one that will provide more information about breastfeeding and safe sleep to at-risk parents. Others establish a state maternal-fatality review team and require Medicaid to cover lactation consulting, breastfeeding equipment, and in-home and telehealth services. The bill also requires state health officials to compile an annual report about the number and types of delivery procedures performed at each hospital. Other sections of the bill will not take effect until 2025. This bill includes the “Momnibus” bill, which was originally filed as HB10 by Moser.

Medical cannabis: HB 829, sponsored by Rep. Jason Nemes, R-Middletown, updates some aspects of Kentucky’s upcoming medical cannabis program. It allows schools to ban medical cannabis from their campuses and allow local governments to apply a small fee to the program, among other changes. Three sections of the bill related to applications for business licenses, state enforcement and patient pamphlets will not take effect until 2025.

Pseudoephedrine: HB 386, sponsored by Rep. Robert Duvall, R-Bowling Green, eases purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their medical needs.

Vaping in schools: HB 142, sponsored by Rep. Mark Hart, R-Falmouth, bans all tobacco, alternative nicotine and vapor products in Kentucky public schools. It also requires school districts to adopt disciplinary procedures for students who violate the bans.

Veteran suicide prevention: Under HB 30, sponsored by Rep. Michael Meredith, R-Oakland, the Kentucky Department of Veterans Affairs will create a suicide prevention program for service members, veterans and their families.

Youth medical records: HB 174, sponsored by Rep. Rebecca Raymer, R-Morgantown, stipulates that parents have access to their child’s medical records. Prior to this law, children ages 13 and older had to sign a waiver for parents to have access.

Alzheimer's education: HB 459, sponsored by Moser, requires advanced practice registered nurses and physician assistants who primarily work with Kentuckians ages 50 years and older to undergo continuing education related to the detection and treatment of Alzheimer’s and other forms of dementia. This language was added from SB 211, sponsored by Sen. Stephen Meredith, R-Leitchfield, in the final days of the session. The bill also involves the APRN national certification exam and Kentucky Board of Nursing appointments.

The Capitol Update, a publication of the Legislative Research Commission, contributed to this story.

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Local governments mulling ways to use opioid settlement funds

KFF Health News graphic

By Zacharie Lamb
WKMS

More than a year after local governments across Kentucky began receiving shares of the legal  settlement with opioid manufacturers and distributors, several local leaders in far western Kentucky are still figuring out how best they can use those funds to tackle the opioid epidemic.

State governments across the country have been tasked with stewarding a portion of funds acquired through regional and national opioid settlements with companies including Johnson & Johnson, McKesson and CVS. The settlements stem from multiple nationwide lawsuits against the firms for their role in fueling the opioid epidemic.

According to the Centers for Disease Control and Prevention, around 75% of drug overdose deaths were connected with opioids in 2022. That accounts for the deaths of more than 81,000 Americans that year. Kentucky’s Justice and Public Safety Cabinet said in its 2022 Overdose Fatality Report that a little over 1,500 people who died from overdoses in the state were found to have fentanyl in their system.

State governments and localities are using the settlement funds to try to heal communities affected by the opioid crisis and prevent others from being affected.

Kentucky has secured around $900 million from the settlements. Those funds have been split into two pools, with half earmarked for a state commission and half divvied up among the state’s county and city governments. The state sent the first installments to local governments in December 2022. Payments are expected to continue until 2038, with no deadline for when funds must be spent.

Lauren Carr. opioid-settlement adviser for the Kentucky Association of Counties, helps county officials follow the best practices and reporting guidelines for the settlement funds.

“You can't take these funds and use it for a program that was already being funded. You can't take these funds and supplant. These funds are supposed to be to supplement,” Carr said. “Either integrate a new program or supplement the existing programs that you have – seeing where barriers are – and providing those services.”

(However, Morgain Patterson, director of municipal law with the Kentucky League of Cities, told Kentucky Health News that while some states prohibit opioid settlement dollars from being used to fund existing programs, called supplanting, Kentucky's statute does not, "so they could be used for current programs . . . as long as they relate back to opioid-use disorder or co-occurring substance-use disorder and mental health issues." For example, she said settlement money could be used to purchase Narcan, even if the city or county is already paying for it. That said, Johns Hopkins University has put together a document of principles it supports that says, 'Jurisdictions should use the funds to supplement rather than replace existing spending.' This document is posted on KACo's website.)

The law creating the state opioid commission has a list of 29 possible uses for the funds. Carr said the list provides pathways for localities but doesn’t expressly limit their use.

The Paducah Police Department is using some of the city’s settlement dollars to staff a new position focused on lowering recidivism for the people with substance-use disorder. Police Chief Brian Laird said hiring a deflection specialist has been a long-term goal for his department.

“We encounter folks regularly that are homeless, folks that have mental health issues, folks that have drug abuse issues,” Laird said. “Instead of the officers continuing to respond over and over to these folks, we have somebody that can follow up with these individuals and try to get them some help.”

Deflection is a relatively new philosophy in law enforcement that focuses on keeping individuals with substance-use disorder from entering or re-entering the court system by avoiding interactions with police. Laird said that he’s aware of other social-work positions in police departments in Kentucky but believes Paducah may be the first in the state to hire a deflection specialist.

The position will be paid partly by the department's budget, but most of the funding comes directly from settlement money. Applications for the position closed in April, and Laird hopes the specialist to be on board by August.

Other county and city governments in far western Kentucky are still trying to figure out how to spend their portion of settlement funds.

Murray officials formed a work group before the first payments were received to investigate possible uses of the funding. City Administrator Jim Osborne said the city is still working with the state Attorney General’s office, which oversees the opioid commission, but that no official plans have been made.

“The goal would be using the money to not necessarily just in one area of but could combine areas that are approved uses,” Osborne said. “I think the key is finding a happy medium of where best it would be used … something that's legal, transparent and would help the community.”

Similarly, Marshall County Judge-Executive Kevin Spraggs said he wants to make sure settlement funds are used in the most efficient way possible.

“We want to make sure wherever this money goes, ultimately, it's put to the best possible use,” Spraggs said. “We don't want to jump into something without doing a lot of research, and we'd like to do something with a proven track record, percentage wise, where the most people are being helped.”

For Carr, addressing the opioid epidemic has two major components – prevention and harm reduction. She said that many localities focus on prevention, with programs like “Just Say No” to kepe people from becoming substance users in the first place. Harm reduction focuses on helping individuals who are already using drugs.

The list of 29 potential uses include programs for intervention, treatment and recovery services for substance users. The funds could also be used to educate the general public and provide training to health care providers, recovery specialists or law enforcement.

The list also includes things like drug take-back and disposal programs and expenss for naloxone, branded as Narcan, that can block opioid overdoses. Carr said that increasing accessibility to the medication and teaching the public about its use could help to prevent deaths.

“At the end of the day, a dead person doesn't recover,” Carr said. “We all can be first responders. Whether it's at a basketball game, at the library or at a Walmart, you never know when you may be a first responder, and so being prepared is something that will help save lives for individuals that are in active addiction right now.”

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Mental-health care access can be a challenge in Eastern Kentucky; on top of that, the subject still carries stigma for some

Appalachian Region Healthcare Behavioral
Health Facility (Photo submitted to WEKU)

By Stan Ingold

WEKU

Experts are concerned about a growing mental-health crisis nationally. This story looks at the struggles faced by those dealing with access to mental-health care in Eastern Kentucky.

“We're Appalachian people, so we're seen as being strong and that's how we want to portray ourselves, and if you have any kind of mental illness it is seen as a weakness," Kasey Wright says.

Wright is the system director of behavioral health, education, and psychological support for Appalachian Regional Healthcare. She said mental health carries a stigma for many people in Eastern Kentucky, and she and her colleagues try to persuade their patients otherwise.

“We try to tell our patients . . . if you have diabetes you have to treat that, its a medical condition. It's the same if you have depression, you have to treat that, it's a medical condition.”

For some, it takes a major incident for them to make the decision to seek help.

“I had a suicide attempt when I was 21,” said Valeri Jones of Morehead. She reached her tipping point almost 20 years ago. She said dealing with substance abuse and anxiety was getting to be too much for her to handle.

“I just couldn't live like that. I couldn't live feeling depressed and I couldn't function. I couldn't work. I lost my job. I just couldn't function,” she said. “So, that is when I was like, 'It's time to do something. It's a true, real chemical imbalance.'”

But it hasn't been an easy road. Once she started getting help, it was hard to find consistency with her treatment, she said: “My appointments would get canceled, they would get rescheduled and every third or fourth appointment that I would finally make it in for, now, some of that was my fault, I would have work or scheduling conflicts or whatever, when I would make it in, I was constantly with a new therapist.”

And she said seeing a new therapist every other visit was a struggle in and of itself.

Jones said it is frustrating because she is constantly told she needs to pair her medications with therapy.

“I'm told by my doctors that 'You need to pursue counseling, you need to be in therapy while taking these medications, because this is the most effective way to deal with your issues.' But then I'm trying to keep up my end of the bargain; but then I keep getting canceled and told, 'Basically, it doesn't really matter.'”

She said sometimes it makes her lose heart. “And it makes me not want to go, and I'm limited with what providers I have access to.”

Jones works in the mental-health field herself. She knows it isn't easy for those trying to help.

“I get it; the pay is not great, the work is demanding, it's mentally exhausting, but as someone on the other end of that, who is trying to get those services for myself, and someone with anxiety, it's hard to, it's hard to just go in and talk to someone period.”

This isn't the only hurdle people face. Kasey Wright, with ARH, said that in southeastern Kentucky, sometimes even just getting to an appointment is difficult.

“We don't have Uber. We don't have taxis here. We don't have things like that. Most of our people live in hollers and things like that, that aren't close to town, so it's really hard for our people to get a ride to any of their appointments.”

Paulina Jones is the director of counseling and psychological services at ARH. She said public transportation isn't much of an option either.

“Our public transportation, when you have to make an appointment for them to come and get you, you have to do it three days in advance. So, some of our patients don't even have telephones, and even for wi-fi, there isn't good wi-fi service either.”

Paulina Jones said another stumbling block for those seeking help is finances. Many of the people who get help from ARH are on Medicaid, but for others, it can be much more difficult to pay for treatment.

“But if you have Medicare, only certain providers can get paid for that. And if you have private or insurance, you're only allotted so many days of like, outpatient therapy, so you may be only getting like 10 days to clear up whatever the issue is. And if you have trauma and something like PTSD you're probably not going to get that healed up in 10 sessions.”

Both Paulina Jones and Kasey Wright say they are seeing more funding being directed toward mental healthcare, but they would like to see officials do more.

Jones said while they have several inpatient facilities for those dealing with substance use disorder, there needs to be something set up for long-term, lower-level mental-health care, for exemple, because there are few personal-care homes in the region.

She said there are "no nice facilities for our chronically mentally ill to go and live and live the rest of their lives and not have that high recidivism, keep coming into the hospital because of the living conditions or not having a safe place to go.”

Along with funding, other efforts are underway. Earlier this year, Gov. Andy Beshear signed into law House Bill 385, known as Seth’s Law. Officials say the law will result in fewer citizens needing to be placed under state guardianship to access health care.

The bill honors the memory of Seth Stevens, who was an advocate for mental health reform, who died by suicide in 2023.

Anyone who may be experiencing suicidal thoughts or any kind of mental health crisis can call or text 988, 24 hours a day, seven days a week to speak to someone qualified to help. Click here to learn more about the 988 Suicide and Crisis Lifeline. 

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Program for mothers and pregnant women with substance-use disorder gets grant to help more Black women get its services

Freedom House (Photo provided to Kentucky Lantern)

By Sarah Ladd

Kentucky Lantern

The Volunteers of America chapter that includes Kentucky will spend $123,000 over the next nine months to figure out how to get more Black women into treatment for substance-use disorder.

Volunteers of America Mid-States received the money from the Kentucky Association of Health Plans, the trade group for health insurers in the state, to fund a new initiative called Access Justice.

With the grant money, scholar, writer and activist Brandy Kelly Pryor will evaluate VOA’s Freedom House, which is a program for “pregnant and parenting women” who have substance-use disorders. Her report is due in April.

The 31-year-old program, with locations in Louisville and Manchester, also lets minor children (under the age of 18) stay with their mothers during treatment. Kelly Pryor will primarily study Louisville and may branch out elsewhere at later.

Jennifer Hancock, president and CEO of Volunteers of America Mid-States, said this move is in direct response to the high rates of maternal mortality among Black women and the disproportionately high overdose rates among Black Kentuckians.

Kentucky overdose deaths decreased in 2023 for the second year in a row, according to the state's Drug Overdose Fatality Report.

In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and/or fentanyl.

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, was involbved in 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine was involved in 55% of 2023’s overdose deaths.

Despite the overall decrease in the state, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.

A 2023 state report on maternal mortality also showed substance-use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky, 88%, are preventable, says the report from the state Cabinet for Health and Family Services.

Black partcipants at Freedom House's Kentucky locations are less likely to complete its program than those of other races, Hancock said.

“I think some of it is about the stigma that they face coming into treatment,” Hancock said. “I think that there could be some cultural and familial pressures that they experience disproportionately.”

Kelly Pryor’s study is expected to provide answers as to why Black Kentuckians leave the Freedom House program without completing it, she said.

“Women, generally speaking, have to be convinced that they deserve treatments and that they are worthy of getting this help and support versus trying to do it on their own,” Hancock said.

In her analysis, Kelly Pryor will “identify gaps in care and opportunities for improvement, ensuring that substance-use-disorder recovery services are equitable and accessible for everyone who needs them,” VOA said. The nonprofit will then come up with plans to fill any gaps in care and access.

Hancock doesn’t know if the solution will be “an internal-to-VOA process that needs to be improved, or if it’s more of a public campaign that we need to wage to reassure Black women that they’re worthy of treatment, that treatment is a place where they can feel supported and feel seen and heard.”

The measure of success, Hancock said, will be when VOA and Freedom House start seeing “better engagement rates of Black women” and higher program completion rates.

Kelly Pryor said in a prepared statement, “Building on principles of healing justice, we will ensure a process that facilitates those most affected, leading us toward the best solutions for recovery and prevention. This effort will take time and involve critical self-reflection, yet the return will have an indelible impact on Kentucky and beyond.”

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As part of resetting its relationship with rural hospitals, UK will not build a new hospital at interstate junction in southeast Lexington

By Al Cross

Kentucky Health News

The University of Kentucky will not build a hospital in southeast Lexington because it wants to do what its network of rural hospital partners want: focus on its mission as a top-level care facility for the sickest patients, a UK vice president told a legislative subcommittee Wednesday.

Mark D. Birdwhistell (UK photo)

The proposed Hamburg-area hospital "was perceived as us stepping outside of our swim lane" by the university's clinical affiliates out in the state, Senior Vice President for Health and Public Policy Mark Birdwhistell told the Budget Review Subcommittee on Health and Family Services.

"We heard loud and clear, 'We want UK HealthCare to focus on taking care of the sickest of the sick. We don't want UK out doing primary care and secondary care.' . . . That was very eye-opening."

Birdwhistell reiterated, "The message we received loud and clear from our clinical affiliates was, 'When our folks get that sick, we want them to come to UK. We want them on campus. We don't them in a community hospital.'"

UK was in the planning process for a new hospital at the southern junction of Interstates 75 and 64, and had bought the property and done some initial work. Instead of a hospital, Birdwhistell said after the meeting, UK will build a clinic with specialty services like the one it has built in a former department store in the Turfland Center in southwest Lexington, but larger: "Turfland plus."

The university will also build other clinics to serve its employees in Lexington and the Bluegrass region, many of whom are "having to get health care outside the system," Birdwhistell told legislators. "We feel like that is our obligation."

Birdwhistell was speaking to the subcommittee in a new role, which he said will include centralizing the university's "government-relations activities across campus," including "building a better partnership with the General Assembly. I felt I was uniquely positioned to do that."

 

Previously, Birdwhistell was UK HealthCare's vice president for health system administration and chief of staff. He was secretary of the state Cabinet for Health and Family Services under Republican Gov. Ernie Fletcher, and helped Republican Gov. Matt Bevin propose changes to the federal-state Medicaid program, which he had run before becoming cabinet secretary. He appeared with Angela Dearinger, executive vice dean of the UK College of Medicine, who was briefly health secretary at the end of Bevin's term.

The General Assembly is firmly controlled by Republicans. In the recent legislative session, Birdwhistell was the university's point man in changing legislation that helped Pikeville Medical Center and some other rural trauma hospitals but in its original form would have reduced some of the extra Medcaid payments that UK gets for being a "safety net" hospital.

That relates to UK's recent takeover of other hospitals in Ashland and Morehead, which Birdwhistell discussed at Wednesday's legislative subcommittee meeting. Speaking of UK's absorption of King's Daughters Medical Center in Ashland, he said "Where we failed . . . is when you put that UK brand in front of that name, that brings with it an expectation of service, not predator," which he said was the perception of some.

"And so, we're readjusting a lot of the narratives to say, 'When you have UK in front of your name, you go to a partner and say, 'What can we do to help you be successful?' It's not 'What do we do to crush you?' And this is community health care. This is not our forte, so we've learned that lesson. . . . We can grow the workforce for those providers and not have to do it ourselves."

Birdwhistell said UK can also serve as a backstop for its rural partners, noting that UK doctors rearranged their schedules one weekend to keep open the neonatal intensive-care unit at Pikeville, which would have had to close temporarily due to employee vacations. "That's what we do," he said. "That's where we excel and that's where we need to get back to."

UK's latest acquisition is St. Claire Medical Center in Morehead, where it has run a satellite medical-school program for several years. The College of Medicine also has satellites in Bowling Green and Northern Kentucky, and Dearinger said it has seven residency programs in Bowling Green, the state's third largest city, and is starting residency programs in Ashland and Pikeville.

"We are trying to grow the number of doctors to stay in our state," Dearinger said, calling UK's Rural Physician Leadership Program "one of our crown jewels." She said it has produced 120 doctors, most of whom are practicing in Kentucky, "the vast majority" in rural parts of the state. Later, she said 42 percent of all recent medical-school graduates from UK have stayed in Kentucky, far above the 24% of "a few years ago."

Two Democratic legislators from Louisville, Sen. Karen Berg and Rep. Lisa Willner, asked Dearinger if UK has had fewer applicants for medical school or residencies due to restrictions on medical education, by which they meant the recent state law that bans abortions except in cases of threat to the woman's life or permanent damage to a life-sustaining organ.

Dearinger said "To be honest, we have not seen a decrease." She said she has heard anecdotal reports of students or graduates interested in obstetrics and gynecology going elsewhere, but "We are still inundated with OB applicants to do a residency at the University of Kentucky."

Another Louisville Democrat, Rep. Sarah Stalker, noted a May 16 Kentucky Health News story, from Kentucky Public Radio, that said 15% fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, and there was a 23% decline in those for obstetrics and gynecology, according to the Association of American Medical Schools., which blamed the decline on the state's near-total abortion ban.

Dearinger said UK is still getting hundreds of "very good applicants, and we don't have any problems filling our residency programs and fellowship programs with very high-quality young physicians. We are prioritizing as much as we can, Kentucky students, so that they will stay" in the state.

Roll call: Most members of the subcommittee did not attend the late-morning meeting. The chairman, Sen. Donald Douglas of Nicholasville, a physician, noted that at the start of the meeting and made an unusually pointed comment: "I expect my colleagues in the General Assembly to show up."

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Study to help reduce risk of heart disease and diabetes is looking for participants on Zoom in 16 Central Kentucky counties

Map by Kentucky Health News

By Gia Mudd-Martin

University of Kentucky

Heart disease and Type 2 diabetes are often preventable, but Kentucky has the nation’s ninth-highest rate of heart disease and the fifth highest rate of diabetes. Plus, many Kentuckians have pre-diabetes but don’t know it.

A team of at the University of Kentucky is leading a health study called “Heart of the Family” to help people learn to reduce their risk for these illnesses, and the team is inviting participants to join.

What do participants get?  

• “Heart of the Family” participants receive eight one-on-one, personalized health education sessions based on their risk factors and health. The sessions are over Zoom — no travel required.
• Free screenings to check health measurements such as blood pressure and cholesterol; these can be done in your home community (team members can come to you) or at an off-campus UK office
• Gift card for participation

Who can join? You may be eligible to participate if you are:

• At least 18 years old
• Do not have heart disease or diabetes
• Live in one of these Kentucky counties: Anderson, Bourbon, Boyle, Casey, Clark, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Marion, Mercer, Pulaski, Scott, Woodford
• Have two or more of these risk factors: family history of heart disease or diabetes; personal history of gestational diabetes or polycystic ovarian syndrome; little or no exercise; unhealthy diet; high blood pressure; high cholesterol; elevated blood sugar; stress; depression; overweight; cigarette smoker

Some participants will be invited to have a friend or family member join with them as a “study buddy,” so make sure you have someone willing to participate with you. They can participate even if they have diabetes or heart disease. Study buddies will receive the same benefits listed above.

What is required of participants? Participants should be willing to complete eight virtual health-education sessions, share health information with the study team, and have blood drawn. All your information will be kept completely confidential, just like in regular medical care.

How can I get involved? If you’re interested in learning more or joining, contact Emily Cravens at emcravens@uky.edu or 859-218-6827. Learn more about participating in research at UKClinicalResearch.com.

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Cigarette tax collections in Ky. dropped after the last two tax increases; the state's smoking rate has also been on the decline

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Increasing state cigarette taxes has proven to be an effective policy to decrease smoking rates, and it appears that is also true in Kentucky.

Nearly 30 percent of Kentucky adults smoked in 2011, two years after the legislature had doubled the cigarette tax to 60 cents a pack. Following a 50-cent increase to $1.10 in 2018, the state's adult smoking rate fell to 17.4% in 2022, the last year for which a rate is available. 

Shannon Baker, the American Lung Association's advocacy director for Kentucky and Tennessee, said that while she could not point to something definitive to explain why Kentucky's smoking rate has been decreasing, as has also been the case in the nation, she could speak to the impact of raising cigarette taxes:

"When taxes increase, smoking rates decline. We should take advantage of that, for goodness sake, and increase the cigarette tax in Kentucky by at least $1 and then tax all other nicotine products at parity with the cigarette tax." 

After the initial boost in cigarette-tax revenue from the rate hikes in 2011 and 2018, revenue from the tax declined 24% from 2019 to 2024.

The legislature increased the tax to 30 cents from 3 cents in 2005, but smoking rates before 2011 should not be compared with those after that because of a change in survey methodology, says the Behavioral Risk Factior Surveillance System, a continuing federal-state poll of Americans' habits.

Baker stressed that its important to take advantage of all policies that are known to decrease smoking. Beyond raising taxes, she said it's important to fund the state tobacco-control program and enforce the law against underage sales, which she said would result in fewer youth becoming addicted to nicotine and growing up to be lifelong smokers, and all the health issues that come with that. 

The new report on state General Fund receipts for the fiscal year that ended June 30 showed a 1.5% increase in receipts from other tobacco products, such as electronic cigarettes or vapes.

Asked about the impact of vaping on decreasing smoking rates, Baker focused her comments on yong people, who are more likely to vape than smoke.

"We really have to get a handle on this youth vaping problem," she said, noing that Kentucky is one of about 10 states that doesn't requrie tobacco retailers to be licensed. "We don't even know where all of these shops are in order to enforce the law against underage sales."

Baker added, "We really need a better method of enforcing the law against underage sales. And what that looks like is licensure and routine regular enforcement opportunities that result in significant penalties all the way up to license suspension and revocation, for scofflaws that routinely violate the law. We're not talking about any onerous policy on those who are compliant with the law. We're simply talking about those who violate the law and violate it routinely." 

The 2023 Youth Risk Behavior Survey found that 5.3% of Kentucky high-school students said they currently smoked cigarettes and 19.7% said they used electronic vapor products. Among middle schoolers, the 2.2% said they smoked cigarettes and 12.8% used a vapor product. "Current use" is considered having used a product on at least one day during the 30 days prior to the survey.

Asked if she thought the new law that bans retailers from selling unauthorized vapor products would be effective in decreasing youth vaping, as it has been touted to do, Baker said, "House Bill 11 turned into . . . an industry market-share grab and nothing more; it is not a protection for kids. What we saw was a bill passing that, in effect would, if it's upheld in court, remove certain products, primarily imported products, from the market shelves, which in and of itself is not a bad thing. But, it certainly doesn't protect kids who will just switch to the other products that remain on the shelves." 

The law has been challenged in court. If it holds up, it will go into effect January 2025.

Baker also wanted to make sure people know that the funds for the state's tobacco control program come from the Master Settlement Agreement with cigarette manufacturers, not from the cigarette tax.

"We need to increase funding for tobacco control because . . .  Kentucky has the highest lung-cancer incidence and mortality rates in the entire nation and most of that is due to our high smoking rate," Baler said. "So even though the smoking rate may be declining, it isn't gone. It isn't good, even."

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Kentucky is a national leader in lung-cancer screening, but still has a long way to go to get all eligible people screened

American Cancer Society photo illustration

By Melissa Patrick
Kentucky Health News

Kentucky ranks second among states for lung-cancer screening, but experts say many more Kentuckians need to be screened. Only 10.6% of those at high risk have received screening; the national rate is 4.5%.

A recent study led by American Cancer Society researchers, published in the Journal of the American Medical Association Internal Medicine, shows fewer than one in five eligible individuals in the United States were up-to-date with recommended lung-cancer screening. 

"This research does show an improvement over screening rates reported for previous years. But we clearly, still have a long way to go. We must push harder to move the needle in the right direction,” Dr. Priti Bandi, ACS's scientific director for risk factors and screening-surveillance research, said in a news release.

The U.S. Preventive Services Task Force and ACS recommend annual low-dose CT scans for lung-cancer screening for individuals who:

• are 50 to 80 years old
• smoke or have quit smoking within the past 15 years
• have at least a 20 pack-year smoking history, which means a pack a day for 20 years or two packs a day for 10 years, and so on. A pack year is the number of packs smoked per day multiplied by the number of years the person smoked. 

Jennifer Redmond Knight, who serves as co-principal investigator for the lung-cancer screening project under the Kentucky Lung Cancer, Education, Awareness, Detection, Survivorship Collaborative, said one reasons lung-cancer screening remains low is because it is a relatively new cancer screening. The first recommendations for annual screenings were issued in 2013 and the eligibility for screenings expanded in 2021. 

"What that means is more people are now eligible for screening, which means the percentage of people who have been screened has gone down because there are more people eligible," Knight said. 

Another challenge is stigma, said Knight, who is also an assistant professor in the University of Kentucky's College of Public Health and a member of the UK Markey Cancer Center's Prevention and Control Research Program.

For years, Knight said people with a "significant smoking history" have felt shamed when their health-care providers ask them if they've quit smoking and they haven't, so when their provider encourages this new screening, there are often trust issues.

Knight said much work is being done in Kentucky to reduce stigma associated with lung cancer, largely through the Lung Cancer Screening Program the legislature created in 2022. Knight is on the program's advisory board.

"Kentucky is actually leading the way in many ways with quality lung-cancer screening and addressing the stigmas and helping lung-cancer screening programs throughout the state work in that space," Knight said.

She also talked about the value of early detection, which lets cancer be treated more effectively. Early screening is also important because it can often identify cancer before it spreads or causes symptoms. 

"We have hope now with lung cancer that we never had before," Knight said. "The story used to be if you get lung cancer, you're not going to make it very long. But now there's a story of hope that has to be changed. . . . So there's a lot of cultural shifts around this." 

The cancer society's research found that screening was much less common in persons without health insurance or a usual source of care, and in Southern states, which have the highest lung-cancer burden. Lung cancer is the leading cause of cancer deaths in Kentucky.

Most Kentuckians can pay for lung-cancer screenings through insurance or a program that offers low-cost screenings. Most Kentuckians have access to health insurance because the state expanded Medicaid in 2014, under the Patient Protection and Affordable Care Act, to include people making up to 138% of the federal poverty level. 

"If you meet the eligibility criteria, lung-cancer screening is covered by Medicare, Medicaid and most private insurance plans without cost-sharing. In rare instances where insurance coverage is unavailable, many programs including UK’s Lung Cancer Screening Program, offer screenings at a relatively low cost," Dr. Timothy Mullett of UK wrote in an article to debunk myths about such screenings.

The state Department for Public Health offers a service called Quit Now Kentucky to help Kentuckians of all ages quit smoking. To learn more go to QuitNowKentucky.org, text QUITKY to 797979 or call 1-800-QUIT-NOW.

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Lee Co. harm-reduction chief says 80% of clients are homeless

Jo Ann Fraley runs the harm-reduction program for
the Kentucky River District Health Department.
(Photos by Stu Johnson, WEKU)

By Stu Johnson, WEKU

Homelessness is a reality in virtually every section of Kentucky. Although often thought of as an urban challenge, rural Kentucky also finds the plight of the unhoused a pressing issue. Here's a glimpse of how one Appalachian community is addressing homelessness needs.

There is a gathering spot inside The Hub in downtown Beattyville. It’s the Lee County Health Department's harm-reduction center, where staff work to connect clients with care providers.

The director is Jo Ann Fraley, a social worker who’s worked in addiction and recovery. Fraley said about 80 percent of The Hub's clients live on the streets or are couch surfing, and many don’t realize their health status.

“Lot of them have blood-pressure issues and they don’t even know. A lot of them have diabetes and they don’t even know,” Fraley said. “So, those issues we need to address as quick as we can.”

Fraley said the focus is getting people hooked up with doctors and health providers, because “We can’t expect change if we don’t help with the changing process.”

“They’ve lost hope. They give up. They’ve burnt every bridge that they have with family. And so, they let themselves go and they just think nobody cares about them. And whenever someone goes somewhere and they’re not treated very nice, they don’t go back,” said Fraley.

Another staff member at The Hub is Shawn Maynard, who was a user of oxycontin, pain pills, and then methamphetamine, along with alcohol. Maynard has been clean for six years and works with clients to address barriers. He said the homeless lifestyle itself creates health risks.

“When you’re homeless, your hygiene’s not gonna be good and that’s gonna create infection, staph infection,” said Maynard. “If you do get a cut and you’re not getting the proper wound care for it, it’s gonna get infected.”

Nathan Tipton

Nathan Tipton, a client of The Hub, said he’s been four months clean after struggling with drugs for years.

“I was on meth and drinking real bad and after my papa and mama died, it got worse and stayed out there in the woods for about four and half year; still homeless, but life makes a big difference when you got God on your side,” said Tipton.

Tipton said it’s different from before, he was stealing and robbing to get a fix.

The Lee County Health Department is part of the Kentucky River Health District. District Health Director Scott Lockard said he and Fraley brainstormed over The Hub concept, and said creating bonding relationships is important.

“We form that relationship. We show them that they can be treated with dignity. We establish trust and then when the timing is right and they’re ready for treatment, we can link them to treatment immediately,” said Lockard.

“Health is the foundation for everything. If you don’t have health, you can’t worry about education, you can’t worry about employment. You can’t worry about everything else.”

So, Lockard said that means linking up to a medical home and making sure the clients have a payer source, which for most is Medicaid. He said some don’t even realize they are eligible for the fedreal-state program that provides free medical care to lower-income people.

Lockard said the district is trying to to establish a similar program in Letcher County, and he envisions similar like services in all seven Kentucky River District counties, ideally in the next five years or so. Besides Lee and Letcher, the district also includes Knott, Perry, Leslie, Owsley and Wolfe counties.

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Breathitt, Lee, Jessamine and Nelson counties are certified as Recovery Ready Communities, making 14 in effort's 14 months

Gov. Andy Beshear presents Recovery Ready Community
certificate for Lee County to Scott Lockard and Joanna Fraley
of the Kentucky River District Health Department. (Photo by Al Cross) 

By Al Cross
Kentucky Health News

Four more Kentucky counties have been certified as Recovery Ready Communities, signaling that they have the services needed to help their residents recover from addiction. That brings the total to 14 out of 120; the program began 14 monhs ago. "We've got 106 to go," Gov. Andy Beshear said.

Breathitt, Jessamine, Lee and Nelson counties earned cetification by showing they are able to provide addiction treatment to their 123,000 residents, according to Beshear, who presented Lee County's certificate at a wide-ranging press conference Thursday.

"These communities are stepping up to help fellow Kentuckians who are struggling with addiction," Beshear said. "We are grateful for, and we applaud, their good work."

Scott Lockard, public-health director for the seven-county Kentucky River Disrrict Health Department, accepted Lee County's certificate with Joann Fraley, who runs the department's harm-reduction program, which includes a syringe exchange to prevent disease among intravenous drug users and steer them into treatment.

"The substance-use-disorder problem is the largest public-health issue that we are facing today in Eastern Kentucky and many parts of our commonwealth," Lockard said.

Noting another major topic of Beshear's press briefing, Lockard said, "These great economic-development announcements are fabulous, but each one of those factories need people to work in them Second-chance employment is huge, and we have so many people who are being impacted by substance-use disorder, especially in our part of the state, in Eastern Kentucky."

Lee County's recovery program is based in The Hub, in the health department's annex. "Our motto at the Hub is 'We meet people where they are, but we do not leave them there,' because it's key that everyone who comes through our door is treated with respect and dignity."

Lockard said the program has gotten more 230 people into treatment, including three that morning. They were immediately transported to a treatment facility, Lockard said: "When they're ready, we need to get them in there right then."

When people leave residential treatment, The Hub offrs them 11 support groups, links to second-chance employment and "a ministry that fills the soul," Lockard said. "You know, this emptiness left by drugs, we need to fill it with somethng else, and if we can get individuals back and show them that they have worth, that they have dignity, then we have the possibility to really help them to be gainful members of our society and fill some of these many jobs and just have a higher quality of life."

 

Lockard said substance use must be approached as a disease. "We cannot incarcerate our way out of this problem." He said The Hub includes a court diversion program for low-level drug offenders.

Immediately before the recovery discussion, Beshear and State Police Commissioner P.J. Burnett announced a statewide drug roundup of 206 suspects, mostly on trafficking charges. Burnett said another 50 suspects are still being sought.

To be certified as recovery-ready, a county must have peer-support services, mental-health treatment, addiction treatment, employment services and a stigma-free environment to encourage recovery. The program "encourages communities to provide transportation to and from employment services and job interviews, allowing Kentuckians to make positive changes in their lives while filling much-needed jobs and contributing to the commonwealth’s record-breaking economic growth," a news release from Beshear's office said. 

The release included statements from representatives of the other counties.

“This is a huge step in continuing to move Breathitt County forward in applying for grants that will improve the lives of every person in our county,” said Breathitt County Circuit Court Clerk James Elliot Turner II. “We need to provide every opportunity for each person in Breathitt County to fulfill their potential. This is a win for our people.”

Shauna O’Nan, Jessamine County Health Department harm reduction director, said “There is no set path of recovery, but after going through this certification process, we are confident, as a community, that we will be able to meet people where they are on that path.”

In Nelson County, "Collaboration and community involvement underlie Nelson County’s efforts to provide recovery resources to its citizens," the release said. Jessica Bickett, safe-communities specialist with the Lincoln Trail District Health Department, said “Nelson County has a strong network of community partners who are committed to supporting the recovery community.”

To learn more about the program and to apply for certification as a Recovery Ready Community, click here.

Paths to treatment

If you or a loved one are struggling with addiction, connect to treatment by calling 833-8KY-HELP (833-859-4357). Information about treatment programs all across the commonwealth is available at FindHelpNowKy.org.

Information on how to obtain the life-saving drug naloxone, which is used to reverse an opioid overdose, can be found at that website as well as at FindNaloxoneNowKy.org and FindMentalHealthNowKy.org.

Visit the State Police website to find a post where those suffering from addiction can be paired with a local officer who will assist with locating an appropriate treatment program through KSP’s Angel Initiative.

To find recovery housing, go to FindRecoveryHousingNowKY.org.

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