Website that helps Kentuckians find addiction treatment now helps them find naloxone, the drug that reverses opioid overdoses

Photo from Kelley-Ross Pharmacy Group

Kentucky Health News

The state's FindHelpNowKy.org website, which helps Kentuckians find addiction treatment, now also can help them find places to get naloxone, which reverses opioid overdose.

The website, which has been used over 240,000 times to facilities since its inception in 2018, now also includes social-services resources and locators for recovery housing and mental-health treatment.

During 2022, a Kentukcy survey found that 73 percent of respondents said they didn't know where to get naloxone, sometimes called by the leading brand of it, Narcan.

“We are making it easier for Kentuckians to find the life-saving help they need,” Gov. Andy Beshear said in a press release. “While there is always more work to be done, we are taking another step forward on our mission to help our families fight and overcome addiction.”

Naloxone has become more available thanks to retailers, grants, reduction of stigma associated with addiction, and proactive distribution by community organizations,local health departments, recovery centers and regional prevention centers, the release said.

In addition to the central hub of FindHelpNowKy.org, some of the services can also be reached at FindMentalHealthNowKy.org; FindRecoveryHousingNowKy.org and FindNaloxoneNowKy.org. The latter website provides overdose prevention and response training relevant to people most likely to witness overdose.

“People can and do recover from addiction and mental health issues,” said state Health Secretary Eric Friedlander said. “And our goal of bundling these services in one central location will only make that journey to recovery easier across the continuum of risk.”

The collaborators on this website are the Kentucky Injury Prevention and Research Center and the state departments for Public Health and Behavioral Health, Developmental and Intellectual Disabilities.

“Addiction and mental health issues affect Kentuckians in every county and every ZIP code,” said Dr. Katie Marks, commisisoner of the latter department. “There should be no shame in seeking help and no barriers to finding evidence-based, compassionate care and treatment. These website updates address that at its core – getting our fellow Kentuckians on their road to recovery with resources that are close in proximity and right for them.”

The National Alliance on Mental Illness says 1 in 20 U.S. adults experience serious mental illness each year. In Kentucky, 189,000 adults are reported as having a serious mental illness, the release said.

If you or a loved one are struggling with addiction, the KY HELP Call Center can connect you to treatment by calling 833-8KY-HELP (833-859-4357). Visit the Kentucky State Police website to find a police 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. Call, text, or online chat 988 to connect with suicide-prevention, mental-health and substance-use-disorder counselors. They are available to all Kentuckians 24/7/365, the release said.

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If you are diagnosed with cancer and you smoke, that's one more reason to stop, says UK doctor who co-chaired national survey

Smokers who have cancer have a better chance of overcoming the disease if they stop smoking, but not all cancer-treatment programs do a good job of encouraging patients to quit, according to a national quality improvement project led by the American College of Surgeons.

"The results, published in JCO Oncology Practice, represent one of the largest national surveys examining the quality of tobacco treatment in cancer care in a wide range of clinical oncology settings, including academic facilities and community cancer programs," says a news release about the study.

Timothy Mullett, M.D.

“While many people understand the role of tobacco in terms of causing cancer, they may not understand the impact that tobacco use has when patients are being treated for cancer,” said Dr. Timothy Mullett, medical director of the Markey Cancer Center Network at the University of Kentucky, chair of the surgeons' college Commission on Cancer and co-author of the study.

“Many providers may not think about tobacco cessation in terms of treatment,” Mullett said in the release. “But just like there are effective treatments for high blood pressure or thyroid disease, there are effective treatments for tobacco use. That’s the disconnect we’re trying to highlight in this study.”

Mullett said persistent smoking among patients diagnosed with cancer is associated with many treatment-related complications, including recurrence of the cancer, premature death, and increased treatment costs, Despite these risk factors, polls suggest that nearly 25% of new patients with cancer are smokers, and of the estimated 18 million cancer survivors in the U.S., 16% report they smoke. Many patients report wanting to quit, but fewer than 10% are successful.

The survey by leaders of the surgeons' group found that only 42% of the cancer-treatment programs reported documenting a smoking-cessation treatment plan, 41% reported regularly assisting patients with quitting , providing self-help information (27%), individual counseling (18.2%), and referring patients to an affiliated tobacco treatment program (26%). Only 18% reported regularly prescribing medications for smoking cessation.

“We showed that incorporating tobacco treatment into cancer treatment is feasible and that it can be done in large and small programs,” Mullett said. “Incorporating resources and referrals on tobacco treatment into cancer care requires training and time. Both of those are hard to find in a busy cancer practice, but we need information like this to be recognized by facilities so they can put resources into tobacco treatment and help connect patients with effective resources on tobacco cessation.”

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Contrary to Trump's statement, McConnell says the effort to repeal the Patient Protection and Affordable Care Act is 'largely over'

Senate Republican Leader Mitch McConnell waited for President Biden to arrive for the State of the Union speech Thursday, March 7, in the U.S. House chamber. (Pool photo by Shawn Thew, via The Associated Press)

Kentucky Health News

Obamacare, now into its second decade, is pretty much here to stay.

So says Senate Republican Leader Mitch McConnell of Kentucky, contradicting former President Trump’s comments that he is still looking at ways to repeal and replace the 2010 law,

“We had a fight over that a few years ago,” McConnell told reporters Tuesday, referring to how Republicans fell short of doing that in 2017 because a few of them opposed the reversal.

“If he can develop a base for revisiting that issue, obviously we’d take a look at it, but it seems to me that’s largely over,” McConnell said of the repeal-and-replace effort, which never had a replacement measure.

McConnell's statement "gave voice to the view shared by many Republican senators that the Affordable Care Act, also known as Obamacare, will be the law of the land for the foreseeable future," writes Alexander Bolton of The Hill.

McConnell said, “I’m going to leave the issue development in the presidential campaign up to the campaign.” 

Trump said he is “seriously looking at alternatives” if he is elected and Republicans keep control of the House and regain control of the Senate.

“The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives,” Trump wrote on his Truth Social site last year. “We had a couple of Republican senators who campaigned for six years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!”

Trump exaggerated or misstated the campaign positions of Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and the late Sen. John McCain (R-Ariz.), who "voted with Democrats to defeat a narrowed-down proposal to repeal the Affordable Care Act without putting a new health care subsidy program into effect," Bolton notes.

President Biden defended the law during last week's State of the Union speech.

“Over 100 million of you can no longer be denied health insurance because of a preexisting conditions. But my predecessor and many in this chamber want to take — the prescription drug away by repealing the Affordable Care Act. I’m not going to let that happen. We stopped you 50 times before, and we’ll stop you again.”

The main impact of the law in Kentucky has been the expansion of Medicaid to households with annual incomes up to 138 percent of the federal poverty threshold. In February, 1.56 million Kentuckians, more than a third of the state's population, were enrolled in the federal-state program. For details, incouding county-by-county numbers, go to https://www.chfs.ky.gov/agencies/dms/stats/KYDWMMCC20240215.pdf.

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Coleman wants opioid commission to shift focus to prevention, especially among youth; leaves small door open to ibogaine

By Melissa Patrick
Kentucky Health News 

Kentucky Attorney General Russell Coleman laid out his mission for the next phase of the Kentucky Opioid Abatement Advisory Commission Tuesday, calling on them to focus on building a "gold-standard statewide prevention program" with settlements paid by opioid makers and distributors.

Attorney General Russell Coleman (Photo provided) 

"It's a plan of zealous collaboration, zealous collaboration," he said. "To be successful, the Office of the Attorney General and this commission must have a strong partnership. We must also further connect this body with organizations throughout our commonwealth . . . to focus on that necessary three-legged stool of treatment, prevention and enforcement." 

Coleman called on the commission to focus on prevention as it considers the coming round of grant applications. "I encourage you to place a strong emphasis on boosting Kentucky’s critically needed prevention efforts," he said.

Coleman added that his office is in the midst of developing new youth prevention initiatives that focus on education.  

"When we're in an environment where children are experimenting with these dangerous substances as early as 11 – we're seeing it in late elementary school – we have to have conversations with our kids earlier and earlier," he said. Later adding, "It's our responsibility, yours and mine, to prepare them for this threat they are facing in a new threat environment." 

When asked what his vision for a statewide prevention program would look like, Coleman told reporters that it will be important to look at what states such as Georgia, Tennessee, Virginia and Mississippi are doing. 

He said Virginia has a robust "one pill can kill" prevention effort and Mississippi had rolled out a "very creative approach that uses name, image and likeness of Ole Miss players to be able to engage and get that message out there, to permeate in the social media space. I would love to institute a program here that looks a lot like what is ongoing in the state of Mississippi." 

As for treatment and enforcement, Coleman said Kentucky is doing a great job in most of the state when it comes to treatment beds, and he told reporters that the drug cartels in Mexico are doing a great job of getting these substances into the U.S., which means collaboration is key, saying there is a need to "tear down the silos between federal, state and local" enforcement efforts.

"Again, we have to do very strong enforcement piece, but it has to be alongside a stronger prevention effort and continuing to treat our addicted neighbors," he said. 

In Kentucky, half of the nearly $900 million in settlement money is being distributed among cities and counties, and the other half is controlled by the commission, which is housed in Coleman's office.

So far, the commission has awarded 59 grants totaling about $21.5 million, with 23 aimed at prevention, totaling about $8 million; and 36 toward treatment and recovery, totaling about $13 million, plus $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in Clark, Christian, Daviess, Greenup, Hopkins, Kenton, Knox, Mason, McCracken and Warren counties.

So, only about a fourth of the total state funding from the settlements has gone to prevention, which Coleman wants to emphasize.

Ibogaine

Coleman asked the commission to drop a proposal by its previous director to fund research aimed at legalizing the psychedelic drug ibogaine for drug treatment, saying he had given the idea "careful study, thorough consideration and honest conversation." 

"In that spirit, I respectfully ask this commission to step back from previous proposals to allocate $42 million to ibogaine research and the unproven, expensive clinical trial for a psychedelic that is, as you know, currently a Schedule 1 drug in the United States."

Noting that some call the settlements "blood money," he said "This is too precious to gamble away with that degree of risk at that amount."

He said he will ask Commission Director Chris Evans to propose a $5 million pool of resources for research and innovation grants that could be open to applications for funding research on ibogaine. 

"If someone brings forward an ibogaine research proposal that fits the criteria of this new innovative grant proposal, I hope this commission will give it full and fair consideration," he said. "It's not zero sum."

Ibogaine is a psychedelic derived from the African iboga plant. It is illegal everywhere except Mexico and New Zealand and has been reported to reduce or eliminate drug-withdrawal symptoms, but comes with some risk to the heart in some people. 

The proposal to commit about 5 percent of the settlement money on clinical trials that could lead to federal approval of the ibogaine for treatment of opioid-use disorder was led by former director Bryan Hubbard, who had been appointed by then-Attorney General Daniel Cameron.

Hubbard is continuing this effort in Ohio. The Lexington Herald-Leader reported in late February that he has signed a contract with the State of Ohio. Hubbard told the newspaper he is working for the state to “deliver novel treatment access and research opportunities for veterans and opioid-dependent individuals” and is partnering with an Ohio-based foundation to “create the framework for ibogaine clinical trials in Ohio.”

Bipartisan praise from commission

Commission member Karen Butcher, whose son died of an opioid overdose, told Coleman that she was pleased that ibogaine could still be considered for clinical research. "It's no secret that I've been the loudest proponent for that," she said. 

State Health Secretary Eric Friedlander, after describing himself as on the other end of the spectrum in support of ibogaine, praised the vision of Coleman, who is a Republican.

"I want to thank you. You're laying out a vision for us. You're here with us today. You are really taking the bold step and the responsible step and the brave step of putting yourself out there. Giving us a vision around prevention, addressing head-on some of the things that we haven't agreed on in this committee," said Friedlander, who works for Democratic Gov. Andy Beshear.

Commission member Jason Roop, a pastor who has said he is in recovery, called on Coleman to not lose sight of the fact that addiction is generational, saying it is important to tackle this problem holistically and not in silos: "I would encourage all of us to consider addiction from a holistic standpoint, prevention, treatment, law enforcement, all of it kind of going together to represent our efforts."

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Poll: 12% of U.S. voters say abortion is their top voting issue

Kentucky Health News

About one in eight voters said in a national poll last month that abortion will be the most important issue influencing their votes this year, and most opposed the 16-week abortion ban that former president Donald Trump has reportedly discussed endorsing.

Most voters who say abortion is the most important issue to their vote say abortion should be legal in all cases. "This is a significant shift from elections prior to the Supreme Court’s decision to overturn Roe v. Wade, when abortion voters were largely those who identified as pro-life," says the Kaiser Family Foundation, which sponsored the poll.

Though the issue has become a major dividing line between the major political parties, 43% of Republicans say abortion should be legal in most or all cases. However, "Few Republicans who want abortion to be legal seem ready to buck their party over the abortion issue," the foundation says.

Asked about a national 16-week abortion ban, 58% of voters oppose it; 63% of Republicans favor it.

Kentucky has both a six-week abortion ban and a law that bans all abortions except those needed to save the woman's life or prevent serious, permanent damage to a life-sustaining organ.

The national poll found Americans largely supportive of abortion rights. Examples include:

• 66% support a federal guarantee of abortion rights.
• 86% of adults, including large majorities of Democrats, independents, and Republicans, said they would allow abortion in pregnancy-related emergencies such as miscarriages.
• More tahn 60% oppose making it a crime for health-care providers to mail abortion pills to patients in states where abortion is prohibited, and policies that prohibit clinics that receive federal funds from providing abortions or referring patients to abortion providers.

Asked how they think about abortion, most said it is an issue of individual rights and freedoms (81%), a health-care issue (68%) and a moral issue (62%). Only 41% see it as a religious issue, but 41%of Republicans do.

"Many voters, especially Democrats, see the 2024 election as a high-stakes election for determining the future of access to abortion and contraception," the pollsters said. Half of voters say they think the elections for president, Congress, and state legislatures will have a 'major impact' on access to abortion." That view is driven by Democratic voters (about two-thirds) and those who say abortion is their most important voting issue (about 70%).

The poll was conducted Feb. 20-28, online and by telephone among a nationally representative sample of 1,316 U.S. adults, including 1,072 registered voters. Interviews were conducted in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample and 4 percentage points for the sample of registered voters. For results based on other subgroups, the margin of sampling error may be higher.

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State health chief says measles risk stems from pandemic's anti-vaccine 'ideologies'; discusses how to lose weight, need for sleep

WKYT news anchor Bill Bryant, left, interviews state Health Commissioner Steven Stack, M.D.

By Al Cross
Kentucky Health News

In a wide-ranging TV interview, state Health Commissioner Steven Stack warned Kentuckians that not enough of them are vaccinated for measles, which he said is an outgrowth of reaction to the Covid-19 pandemic and the measures taken against it.

Stack reflected on his work in the pandemic and talked about other health concerns, including the opioid epidemic, weight-loss drugs and the need for Kentuckians to get more sleep, in an interview that aired Sunday on WKYT's "Kentucky Newsmakers" with Bill Bryant.

Stack said measles was declared elimiated in the U.S. in 2000, but it has returned because vaccination rates have dropped to 90 percent. The disease may be the most contagious, and epidemiologists say 95 percent of a population needs to be vaccinated to protect those who can't or won't get the shot.

Stack said the measles-mumps-rubella (German measles) vaccine has been used since 1971, and is very effective. "We’ve got to get the public I hope, to accept that these tools help to prevent us from having far worse problems, like little babies who can't get vaccinated getting seriously ill." Children younger than 6 months are ineligible for vaccination.

Why have vaccination rates dropped? "It's all gotten caught up in the Covid pandemic, in the narrative, in the ideologies that have unfortunately become associated with public health and medical science," said Stack, a physician.

Asked if he and Gov. Andy Beshear made the right calls in the pandemic, he said "I think we did the best we could with what we knew at the time." He said Kentucky outperformed most other states, considering its lower health status, which made it more vulnerable.

Stack said he and Beshear "balanced saving the most poeple [with] other harms that are worse than what you're trying to prevent." He said Kentucky's death toll of 20,000 was "far from what it would have been had we not intervened," noting that an intiial estimate was it could lose 1 to 2 percent of its population: 45,000 to 90,000 people.

Looking ahead, Stack said people 65 and older and those with other risk factors should get a Covid-19 booster this spring, and everyone should get an annual booster, much like has long been done for influenza.

Other health issues

Kentucky leads the nation in the percentage (about 2.1%) of population that has received a prescription for one of the new drugs created to fight obesity and diabetes, which can also aid weight loss.

"Overweight and obesity is a big problem in Kentucky," Stack said, noting that 38% of Kentuckians weigh too much. "That leads to diabetes, it increased your risk of cancer and cardiovasculat disease, like stroke and heart disease. It's really a major issue for us to address."

As for the drugs, "People are understandably desperate to find ways to get it under control," he said. "It's really too early to say what the long-term outcome of those medications will be. Some people have had wonderful benefits from it, have lost a lot of weight and improved their overall performance. Some individuals have had a difficult time tolerating it: persistent nausea, vomiting, or an unlucky small number with pancreatitis, so time will tell on those.

"Right now I think what we really need to do is try to think about ways to improve our environment so it's easier to eat healthier -- fresh fruits and vegetables -- and do mild things, like just go for a walk three or four days a week for 35 to 45 minutes; if you coudl do simple things like that, most of us could actually lose the small weight that we have to avoid becoming diabetic."

Kentucky is also one of the states most affected by the opioid epidemic. Stack said it has evolved because "The criminals keep getting more creative in the cocktails they put together and they're becomeing more and more lethal for people."

Speaking on the weekend that the nation moved its clocks to daylight saving time, Stack said lack of sleep is also a major health issue, especially for teens, who need more of it.

He said teens and adults "disrupt our sleep" with big and small screens, on TVs and smartphones. "We’ve got to get better sleep hygiene," he said, "and set out the time we need to get that eight hours of sleep."

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State and federal lawmakers say they're still trying to rein in health-insurance middlemen, called pharmacy-benefit managers

By Melissa Patrick
Kentucky Health News

A day after Gov. Andy Beshear talked at a White House roundtable about Kentucky's moving to one pharmacy-benefit manager for Medicaid, First District U.S. Rep. James Comer, spoke at another Washington event about his efforts to reform PBMs as chair of the House Committee on Oversight and Accountability.

U.S. Rep.  James Comer

“The focus of what PBMs' role should be, should be to help the consumer have more choice, have lower costs," Comer said at a March 7 event hosted by The Hill. "But what’s happening is the focus now with the PBMs is which drug can we make the most profit off of, regardless of what’s best for the patient. And I don't think that's a good business model." 

PBMs are middlemen between insurance plans and drug manufacturers; they determine what drugs are offered, how much someone pays for the drug, and how much pharmacists are paid.  

Earlier this year, Comer's committee passed with broad bipartisan support the Delinking Revenue from Unfair Gouging (DRUG) Act, which would rein in practices by some PBMs that offer health plans under federal employees' health program. 

Comer said PBM reform remains a priority, and his committee has received more than 40,000 pages of documents for a report that will be released "very soon." He said his panel will have another hearing once the report is release to discuss next steps.

He said those who understand the issue "realize that PBMs have actually added cost to the consumers" at a time when everyone recognizes that the rising cost of prescription drugs is not sustainable. 

Despite comgressional concern about the issue, the government-funding bills just signed by President Biden do not include PBM reforms. Asked if they coudl pass in the "lame duck" session after the November elections, Comer, using his own committee as an example, said, "I think something can always be done before." 

Comer said much of the problem comes from three major PBMs controlling 80% of the market, noting that they are owned by health-insurance companies and have their own mail-in pharmacies. 

“I believe PBMs have had a negative impact on competition, especially among community pharmacists,” he said. “I believe they have an unfair competitive advantage. I believe they’re doing a lot of things that are unethical at best and should be illegal at worst with respect to – I would even go as far as saying extorting fees from independent pharmacies. We’re losing independent pharmacies.”

Kentucky lawmakers have been working on PBM issues for years. Most recently, in 2020, they passed a bill sponsored by Sen. Max Wise of Campbellsville, a Comer ally, that required the state to hire a single PBM for the state's Medicaid program. Before this law, each of the six companies that manage Medicaid for the state had its own PBM.  

At the White House roundtable, Beshear talked about the legislation and how he began investigating PBMs' drug-pricing methods when he was attorney general in 2016-19.

“That single PBM that answered to us, and not to any other company, has allowed Kentucky Medicaid to maximize drug rebates and has saved our Kentucky families about $300 million since we've done it,” he said. “And it allowed us to understand more about how to get the right price.”

Kentucky PBM reform efforts are ongoing

Wise's latest PBM reform measure is Senate Bill 188, which involves PBM reform efforts on the commercial market.  

State Sen. Max Wise

“I’m optimistic this measure will yield similar savings by applying the same standards to the commercial market, effectively cutting costs for Kentuckians with private health insurance plans,” Wise said in a Feb. 8 news release about the bill.  

SB 188 "aims to empower citizens to choose where they purchase their medication, prevent further closures of community pharmacies and ensure fair reimbursement rates for these essential health care providers," said the release.  

SB 188 has been assigned to the Banking and Insurance Committee. It has not yet been heard or voted on in committee, but has received its first reading, an indication that it has a chance for passage. 

Another bill that addresses PBMs passed out of the House Health Services Committee on March 7. House Bill 190, sponsored by Rep. Scott Sharp, R-Ashland, was approved unanimously and was placed in the House for possioble action as early as Monday, March 11. 

State Rep. Scott Sharp

HB 190, as amended by a committee substitute, would allow people to receive their medication directly from the mail, but if it does not get there in time, they would have the option to purchase it from their local pharmacy at the same price it would cost if it was mailed to them.  

Sharp said he was prompted to file this bill because of a personal experience. 

He said he went to his local pharmacist to get a drug for a family member who was having some trouble getting it delivered. He said he was told it would cost $400, instead of the $36 it would cost if it came by mal. 

Upon talking to his PBM, he learned that this was the "penalty" for using his local pharmacy, instead of getting it mailed direct. Since, he said he's learned that this is a common problem and that's why he wants to "fix it." 

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