Health department director says she has work to do, to educate Attorney General Coleman about syringe exchanges

Dr. Crystal Miller with state
Health Commissioner Stack

Kentucky Health News

The director of a district health department with a syringe exchange has voiced disappointment to her local newspaper over Attorney General Russell Coleman's opposition to the exchanges.

Dr. Crystal Miller, director of the Wedco Health District, which serves Scott, Harrison and Nicholas counties, told the Georgetown News-Graphic that syringe-exchange programs are misunderstood.

“It is unfortunate that our attorney general doesn’t support syringe service programs,” Miller told the newspaper. “We have work to do to educate him on grasping a full understanding of what this program entails.”

Noting Coleman's statements to Kentucky Health News, Miller said, “This program is designed around the very things he’s supportive of, prevention and treatment. We work closely with community partners to create a system that no matter where someone enters, we know how to link them to an agency that can assist. Substance abuse is a problem in our society that we will never enforce our way out of, and successful mitigation requires all hands-on deck. Syringe service programs are a framework for that in our community.”

The News-Graphic notes, "Approval for such a program, here, was difficult and strongly opposed by the Scott County Fiscal Court several times until a magistrate who once opposed such a program became aware of a situation involving someone he knew and reversed his opposition."

Miller said, “At surface level, syringe service programs can be misconceived. This program provides an entry point to many resources for people who use drugs and allows us to promote recovery. Through this program alone, we have referred people to treatment for drug use, linked them to care and resources within the community to help them make better, healthier choices.

"We have success stories of people recovering in every SSP program across Kentucky. However, one of the biggest successes within this program is the amount of hepatitis C and HIV that we have been able to detect and treat within our communities. Without this program, we would not have identified communicable diseases that are killing people and costing taxpayers large amount of money. Just within the Wedco District, through our SSP program, we have saved taxpayers $1.3 million in early identification/treatment of Hepatitis C. We are effective at prevention and treatment and the data proves it."

As for Coleman's concern that syringe exchanges promote drug use, Miller said, “I can assure you that not one participant has ever reached our doors and decided to start using drugs because we are providing clean syringes. We prevent the spread of disease, focus on reducing as many barriers as possible and being a resource to helping people make better decisions and recover, all while saving taxpayers money. I hope that we can work more closely with our AG to help him understand and support the impact that this program has in communities.”

More than half of Kentucky's counties have syringe exchanges.

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Cervical-cancer screening declined in pandemic, UK study finds

A Pap test (Photo by Rabizo, iStock/Getty Images Plus)

By Elizabeth Chapin

University of Kentucky

New research at the University of Kentucky reveals concerning declines in cervical cancer screening rates among women in the U.S. during the Covid-19 pandemic, especially in rural areas.

The study, led by UK Markey Cancer Center researcher Ty Borders, analyzed nationally representative survey data from the National Cancer Institute to examine Pap test screening rates before and during the pandemic. A Pap test (or Pap smear) is a screening method that can detect cervical cancer or cell changes that may lead to cervical cancer, allowing for early detection and treatment.

The analysis showed that the odds of a woman receiving a Pap test in the past year were 30% lower in 2022 compared to 2019, before the pandemic began.
research published in JAMA Network Open 

The substantial decline is concerning, given that cervical cancer is largely preventable with regular screening and early intervention says Borders, a professor in the UK College of Nursing and director of the Rural and Underserved Health Research Center.

The study also found increased disparities in screening rates between rural and urban women. In 2022, only 48.6% of rural women reported receiving a Pap test in the past year, compared to 64% of urban women.

Women from rural areas have historically had higher rates of cervical cancer incidence and mortality, so a widening urban-rural gap in screening during the pandemic is particularly troubling, Borders says.

“The findings point to a need to expand access to cervical cancer screenings among all women, but especially those residing in rural areas, to prevent a possible uptick in future cervical cancer incidence and mortality,” said Borders.

Disruptions to health care services during Covid-19 lockdowns likely contributed to the declines in screening, as many clinics temporarily suspended or scaled back routine procedures like Pap tests.

Based on the results, health care providers may want to consider extra measures to ensure patients are up to date with recommended screenings, including expanding the availability of appointments for cervical cancer screenings and reminding patients of screening due dates.

The research was published in JAMA Network Open, a publication of the American Medical Association. 

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U.S. Supreme Court agrees to hear case challenging laws like Kentucky's that ban gender-affirming health care for minors

Photo illustration by Shutterstock Creative

By Mark Sherman

Associated Press

The U.S. Supreme Court on Monday jumped into the fight over transgender rights, agreeing to hear an appeal from the Biden administration seeking to block bans on gender-affirming care like the one in Kentucky.

The justices’ action comes as Republican-led states have enacted a variety of restrictions on health care for transgender people, school sports participation, bathroom usage and drag shows. The administration and Democratic-led states have extended protections for transgender people, including a new federal regulation that seeks to protect transgender students.

The case involves a Tennessee law that restricts puberty blockers and hormone therapy for transgender minors. The Sixth Circuit U.S. Court of Appeals in Cincinnati allowed the law and a similar one in Kentucky to take effect after lower courts had blocked them. The Supreme Court did not act on a separate appeal from Kentucky and did not explain why.

In their appeal, lawyers for the transgender teens in Tennessee told the justices, “Without this Court’s prompt intervention, transgender youth and their families will remain in limbo, uncertain of whether and where they can access needed medical care.” Arguments will take place in the fall.

Last month, South Carolina became the 25th state to adopt a law restricting or banning gender-affirming medical care for transgender minors, even though such treatments have been available in the United States for more than a decade and are endorsed by major medical associations.

Most of the state bans face lawsuits. The justices had previously allowed Idaho to generally enforce its restrictions, after they had been blocked by lower courts.

Kentucky and at least 23 other states ban transgender women and girls from competing in certain female sports competitions. At least 11 states have adopted laws barring transgender girls and women from girls’ and women’s bathrooms at public schools, and in some cases other government facilities.

The nation’s highest court has only rarely taken up transgender issues. In 2020, the justices ruled that a landmark civil-rights law protects gay, lesbian and transgender people from discrimination in employment.

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth.

The services are offered to treat gender dysphoria, the unease a person may have because their assigned gender and gender identity don’t match. The condition has been linked to depression and suicidal thoughts.

Gender-affirming care encompasses counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes. Those for transgender men cause periods to stop, increase facial and body hair, and deepen voices, among others. The hormones used by transgender women can have effects such as slowing growth of body and facial hair and increasing breast growth.

Gender-affirming care can also include surgery, including operations to transform genitals and chests. These surgeries are rarely offered to minors.

Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed the bans and said that gender-affirming treatments can be medically necessary and are supported by evidence.

But around the world, medical experts and government health officials are not in lockstep. Some European countries in recent years have warned about overdiagnosis of gender dysphoria. England’s health service stopped prescribing puberty blockers to children with gender dysphoria outside of a research setting.

Contributing: Geoff Mulvihill and Carla K. Johnson, AP.

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When it's hot, drink more water; here are ways to get that done

Photo illustration from CDC

Kentucky Health News

Staying hydrated is essential to maintaining health, especially during summer months. Aside from preventing dehydration, the Centers for Disease Control and Prevention reports that water helps your body maintain normal temperature, facilitate joint movement and protection, protect sensitive tissues like your spinal cord and remove waste through sweat, urination and bowel movements.

Here are tips for staying hydrated this summer, and there are more available at cdc.gov/healthy-weight-growth/water-healthy-drinks/index.html.

Upgrade your water bottle. Buying a reusable water bottle to refill throughout the day can help ensure you drink enough water. Freezing pre-filled plastic water bottles can be a great way to make sure you have access to cold water throughout the day, especially if you plan to spend an extended amount of time outside. Consider buying a flavor-infusing water bottle to add fruit flavors to your water if you dislike the taste of plain water.

Cut back on other drinks. Substitute water for sugary drinks like sodas or teas when you feel thirsty and consume alcohol, caffeine and energy drinks in moderation. Sports drinks can be a good way to restore electrolytes after prolonged periods of sweating and heavy physical activity, but avoid consuming them outside of regenerating electrolytes. Remember that choosing to drink water as often as possible will help keep you hydrated.

Make water part of your meals. Water is usually a drink option at restaurants, so choose to order water when given the opportunity. If you plan to host dinners or parties this summer, serve water and water-based drinks with your meals. Serve recipes with fruits and vegetables that contain water, like cucumbers and tomatoes. Whether you plan to eat indoors or outside, consider keeping a pitcher of ice water on the table during meals so guests can refill their glasses as they need to. Add a wedge of lime or lemon to your water.

Some other beverages can be part of healthy eating patterns: Plain coffee or teas, sparkling water, seltzers, and flavored waters are low-calorie choices. Low-fat or fat-free milk; unsweetened, fortified milk alternatives; and 100% fruit or vegetable juice contain important nutrients. Enjoy these drinks within recommended calorie limits. Milk contains important nutrients such as calcium, potassium, and vitamin D.

What about other beverages? Here's what the CDC says:

• Sugary drinks: Regular sodas, fruit drinks, sports drinks, energy drinks, sweetened waters, and sweetened coffee and tea contain calories but little nutritional value. Learn how to Rethink Your Drink.
• Alcoholic drinks: If you choose to drink alcohol, do so in moderation.
• Caffeinated drinks: Moderate caffeine consumption (up to 400 mg per day) can be a part of a healthy diet. That's about 3 to 5 cups of plain coffee.
• Drinks with sugar alternatives: Drinks that are labeled "sugar-free" or "diet" likely contain high-intensity sweeteners, such as sucralose, aspartame, or saccharine. These sweeteners may reduce caloric intake in the short term. However, there are many questions about the sweeteners' effectiveness for long-term weight management.
• Energy drinks: In addition to added sugar, these products may also contain large amounts of caffeine and other legal stimulants. Concerns have been raised about the potential health risks of these products, especially for young people. 

Regularly consuming water during the summer will help you stay hydrated and healthy. Find more resources about water and hydration at nutrition.gov/topics/basic-nutrition/water-hydration-and-health and heart.org/en/healthy-living/fitness/fitness-basics/staying-hydrated-staying-healthy.

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FDA OKs menthol e-cigs made by company Altria recently bought, endorsing its smoking-cessation claims; health advocates object

By Matthew Parrone
Associated Press

The Food and Drug Administration on Friday authorized the first menthol-flavored electronic cigarettes for adult smokers, acknowledging that vaping flavors can reduce the harms of traditional tobacco smoking.

Njoy menthol product

The FDA said it authorized four menthol e-cigarettes from Njoy, the vaping brand recently acquired by tobacco giant Altria, which also sells Marlboro cigarettes.

The decision lends new credibility to vaping companies’ longstanding claim that their products can help blunt the toll of smoking, which is blamed for 480,000 U.S. deaths annually due to cancer, lung disease and heart disease. E-cigarettes have been sold in the U.S. since 2007 but in recent years their potential benefits for smokers have been overshadowed by their use by adolescents and teens.

Parents and anti-tobacco groups immediately criticized the decision, which follows years of advocacy efforts to keep menthol and other flavors that can appeal to teens off the market.

“This decision could mean we’ll never be able to close the Pandora’s box of the youth vaping epidemic,” said Meredith Berkman, co-founder of Parents Against Vaping E-cigarettes. “FDA has once again failed American families by allowing a predatory industry to source its next generation of lifetime customers — America’s children."

Youth vaping has declined from all-time highs in recent years, with about 10% of high schoolers reporting e-cigarette use last year. Of those who vaped, 90% used flavors, including menthol.

In Kentucky polling in 2021, 45% of high-school students said they had used an electronic vapor product, 22% were current users, 8% were frequent users, and 7% used the products daily. Among Kentucky middle-school students, 24% said they had used an electronic vapor product, 11% said they were current users, nearly 3% said they were frequent users, and 2% said they used the products daily.

All the e-cigarettes previously authorized by the FDA have been tobacco, which isn't widely used by young people who vape.

Njoy is one of only three companies that previously received FDA's OK for vaping products. Like those products, two of the Njoy menthol varieties come as cartridges that plug into a reusable device that heats liquid nicotine, turning it into an inhalable aerosol. The other two Njoy menthol products are disposable e-cigarettes.

Njoy’s products accounted for less than 3% of U.S. e-cigarette sales in the past year, according to Nielsen. Vuse, owned by Reynolds American, and Juul control about 60% of the market, while hundreds of disposable brands account for the rest.

Most teens who vape use disposable e-cigarettes, including brands like Elf Bar, which come in flavors such as watermelon and blueberry ice.

Altria's data showed Njoy e-cigarettes helped smokers reduce their exposure to the harmful chemicals in traditional cigarettes, the FDA said. The agency stressed the products are neither safe nor “FDA approved,” and that people who don’t smoke shouldn’t use them.

Friday’s action is part of a sweeping FDA review intended to bring scientific scrutiny to the multibillion-dollar vaping market after years of regulatory delays. The U.S. market includes thousands of fruit- and candy-flavored vapes that are technically illegal but are widely available in convenience stores, gas stations and vape shops.

The FDA faced a self-imposed court deadline at the end of this month to wrap up its yearslong review of major vaping brands, including Juul and Vuse.

Those brands have been sold in the U.S. for years, awaiting FDA action on their scientific applications. To stay on the market, companies must show that their e-cigarettes provide an overall health benefit for smokers, without significantly appealing to kids.

“Based upon our rigorous scientific review, in this instance, the strength of evidence of benefits to adult smokers from completely switching to a less harmful product was sufficient to outweigh the risks to youth,” said Matthew Farrelly of FDA’s Center for Tobacco Products.

Richmond-based Altria previously took a $13 billion stake in Juul in 2018, when the brand controlled most of the U.S. vaping market. But Juul's value plummeted after it was hit with lawsuits and investigations over its role in sparking a national spike in underage vaping.

Two of the four FDA-approved products are "sealed, pre-filled, non-refillable pods that are used with a previously authorized Njoy device, and two are disposable e-cigarettes with a prefilled, non-refillable e-liquid reservoir," Jessica Kairns reports for Inside Health Policy.

Several longtime health-advocacy groups criticized the decision.

American Lung Association CEO Harold Wimmer wrote, “The tobacco industry has been using menthol and other flavors to attract kids for decades - this opens up a legal pathway for Njoy to market their highly addictive products.”

Lisa Lacasse, president of the American Cancer Society Cancer Action Network, noted that the move comes less than two months after the Biden adminisration announced an indefinite delay in FDA’s proposed rule to ban menthol cigarettes and flavored cigars, which had bene pending for two years.

"FDA has been more closely scrutinized by Congress over its e-cigarette regulation approach in recent months," Kairns notes. "Lawmakers in both parties agree FDA isn’t doing enough to combat illegally imported e-cigarettes, but a partisan divide is emerging on whether the agency should respond by approving more domestic products. Some Republicans have suggested the agency should approve more applications for American companies’ products while Democrats largely want those products off the market as well."

In its announcement, "FDA appeared to respond to criticisms," Kairns writes. Center for Tobacco Products Director Brian King said, “This action is further reinforcement that authorization of an e-cigarette product is possible when sufficient scientific evidence has been submitted to the agency to justify it.” 

King said Njoy submitted evidence "showing a benefit to adult smokers relative to the company’s previous tobacco-flavored products that is sufficient to outweigh risks of the products, including potential appeal to youth."

Kairns notes, "FDA’s statement says authorization of the products does not mean they are safe, adding that people who do not use nicotine products shouldn’t start. It also says the agency remains concerned about youth vaping. It will monitor the marketing of the Njoy products levels of use of the products among youth and former smokers, and the number of smokers who are able to completely switch to the products."

Under the FDA rule, Njoy may not "use most advertising methods," and ads "cannot include cartoon images, images of food or fruit, or depictions of people who appear to be younger than 45," Kairns reports. "Retailers must place Njoy products only in non-self-service areas of stores."

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Community event at church addresses health needs in Frankfort

A variety of health-focused vendors set up tables in the parking lot of First Baptist Church Frankfort on June 14 to share information and host activities with attendees. (UK photo by Lindsay Travis)

By Lindsay Travis
University of Kentucky

Coretta Scott King said, “The greatness of a community is most accurately measured by the compassionate actions of its members.”

On a warm Saturday in June, First Baptist Church Frankfort opened its doors to more than 500 individuals in the community to put an emphasis on their well-being. It was part of the fourth annual Dr. Rosby L. Glover Unity in the Community event — a day of fun, food, music and raising awareness.

The fruits of this effort are an extension of collaborations with key community partners, including Capital City Activity Center, Meals on Wheels Greater Frankfort, Kentucky State University Cooperative Extension and the University of Kentucky.

“The day is an effort to bring the whole community together, to not only just have fellowship, but to bring awareness to physical health, diabetes and other health issues,” said Bishop Tiangello Hill, senior pastor of the church. “It means that we're doing our job. It means that we are reaching beyond the four walls and being a help to all mankind.”

The event is held in honor of the church’s late pastor, the Rev. Dr. Rosby L. Glover, who made it his mission to be an advocate for the Frankfort community for children and families. His widow, Lady Kimberly Glover, said “This was a vision of ours, and I’m elated to see Frankfort continue my husband’s mission to serve the community and its families.”

The compassion for Frankfort is evident in talking to those behind the June 14 event, like Glover.

“People care about this event because when people get together, we're all just people,” she said. “No matter what race, what nationality, it’s bringing love for one another, showing how much we care. And just to know that the church is here to help anyone in need.”

In an effort to share important health information with the community, inside the church, guests could complete free health screenings. The Lions Club partnered for diabetes screenings and the Franklin County Health Department donated screening materials and time for blood pressure screenings.

UK's Refocus Project, aimed at Blacks, answered questions
about opioid overdoses. (UK Photo by Lindsay Travis)

Tents and tables lined the church parking lot and nearby Clinton Street showcasing the services provided by a variety of health-focused agencies. Among those tables were UK’s Sanders-Brown Center on Aging and its Engaged Aging Lab, the College of Health Sciences’ Physical Therapy program, the Research Examining Factors Associated with the Opioid Crisis among Underserved African Americans (REFOCUS) research team, and the Cooperative Extension Service.

It’s an intentional approach from researchers and clinicians at UK to address the specific needs of the Frankfort community. The city, at one time, had the nation’s second-highest prevalence of Alzheimer’s disease in African American adults among other health challenges.

The partnership is an important one to Elizabeth Rhodus, assistant professor at Sanders-Brown and the Department of Behavioral Science in the UK College of Medicine.

“We connected with Dr. Glover a few years ago to think about how we can help provide health care, access and resources to individuals in the community,” said Rhodus. “We are excited to see that partnership grow.”

Saturday’s event is an extension of Sanders-Brown’s partnership with First Baptist Church Frankfort. Researchers meet monthly with church members to help address the commumity's needs. It’s part of Rhodus’ Engaged Aging Lab, which takes lessons learned from research and clinical spaces out into the communities to address health gaps.

Rhodus and her team provide support and resources for Alzheimer’s disease and dementia through research which focuses on everyday activities that support healthy brain aging, caring for individuals with dementia and community-engaged research for health equity. They use practical methods and everyday items in ways to help people live healthy and reduce their risks for diseases.

“We focus on telling people about five main areas to try to reduce your risk for dementia: sleep, nutrition, exercise, novelty — or doing something new — and socializing, are the great things for your brain,” said Celeste Roberts, research program manager at the Engaged Aging Lab.

Roberts kept a bottle of lavender-scented lotion and an oil timer on the table. The items may be simple, but as Roberts explains, they can relax the mind and body through aromatherapy and visual cues.

She and Sanders-Brown’s April Stauffer answered questions from people stopping at their tables for hours. They handed out helpful flyers on a range of topics related to brain health.

“Having a conversation with people about what they can do every day on their own and giving them the tools they need to ask the right questions about their health is key,” said Roberts. “Unity in the Community gives us an opportunity to start that conversation.”

On Clinton Street in downtown Frankfort, physical therapy students looked like they were playing games with attendees who stopped by their table. In actuality, they were conducting fall risk and balance assessments they’d use in clinic — a four-square step test and a timed up-and-go test out of a chair.

“Depending on how they score we can tell them if they’re at an increased risk for falls or not and provide them with helpful information,” said Sheila Clemens, an assistant professor in the Department of Physical Therapy. “This community is potentially at risk for being underserved and they may not get this information elsewhere. We’re happy to offer this easy access.”

In the next booth, the focus was on engaging members of the Black community in research. It’s part of the REFOCUS project, led by Danelle Stevens-Watkins, acting dean and professor in the Department of Educational, School and Counseling Psychology in the College of Education.

“We came to this event to help educate the community about opioid overdoses,” said Mona Goggins, a research assistant with REFOCUS. While the number of overdose deaths in Kentucky declined 9.8% frpom 2022 to 2023, there was an 8% rise in overdose deaths among Black Kentuckians. “Our hope is people want to participate in our study so we can increase awareness and gather information that will improve treatment in the Black community.”

The project is primarily focused on Lexington and Louisville, but the REFOCUS representatives shared that guests were “getting what they needed from the table” from education to sharing stories to seeing themselves represented in research efforts.

“I think that when you try to look at treatment from just one lens, you miss out on so many different groups in the population. I think it's important to recognize what different cultural backgrounds and factors that influence people's lives in the way that they experience opioid use,” said De’Asia Beard, a REFOCUS mresearch assistant.

UK’s Cooperative Extension Service has been a long-time partner in this community initiative. Sanders-Brown works closely with Carla Carter, an extension agent for family and consumer sciences at the Franklin County Extension Office.

Carter, a long-time member of First Baptist Church Frankfort, helps coordinate monthly workshops at the church and was the emcee for the Dr. Rosby L. Glover Unity in the Community. She thanked Debora Bobbitt and Reverend Anna Jones for organizing the day.

The event took a holistic approach to community health, with pieces focused on the spectrum of age ranges represented. In addition to health screenings for older age groups, the church donated 65 bicycles to kids in the community — doubling their previous giveaway goal — to foster health and exercise.

It took a team of people to put on the event and a strong spirit of collaboration from the team at the church to make such an impact in the capital city.

Rhodus and her team know there’s a health need in this area that can benefit from targeted resources and outreach paired with different research approaches. The team shares a similar goal with First Baptist Church Frankfort:

“Let’s literally build unity within all of these communities to support every individual, wherever they’re at in their aging journey — childhood all the way throughout their older age,” said Rhodus. “Let’s tailor the health pieces that they need to support a healthy, active lifestyle.”

Where to find more information:

• Sanders-Brown offers a variety of resources for people with questions about brain health. You can get started online here.
• The Engaged Aging Lab is ready to help caregivers and community members. You can find those resources online here.
• Anyone with questions about the study REFOCUS and opioid use in the Black community can email REFOCUS@uky.edu.
• UK’s physical therapy program also offers clinics for the public. More information is available online here.
• The Cooperative Extension Service provides practical education to help people, businesses and communities solve problems, develop skills and build a better future. Find more about their services online here.
• The Kentucky State University Cooperative Extension Program strengthens underserved communities, families, farmers, individuals and youth to improve their quality of life with state-of-the-art, research-based educational programs. You can learn more about their services online here.

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Huge grant fails to reduce ODs by 40%; does show a 9% drop over four states, saving an estimated 483 lives, but few in Ky.

The National Institues of Health’sNational Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration funded the study through the NIH HEAL Initiative.

By Melissa Patrick

Kentucky Health News

A four-state, $350 million research grant that included Kentucky fell far short of its goal of reducing opioid overdose deaths by 40% over four years, instead showing an estimated 9% drop in such deaths. 

"That translates into an estimated 483 opioid-overdose deaths that were averted in the communities that received the intervention," said Patricia Freeman, part of the HEALing Communities Study research team and an associate professor of pharmacy at the University of Kentucky.  

Another model, comparing those to communities to a control group of counties with similar charcteristics, showed a 15% average reduction in opioid-overdose deaths in the intervention communities, which Freeman said was "very close to reaching statistical significance."

"It's still consequential even though it didn't reach statistical significance," said Freeman. "An estimated 483 lives were saved. And just because it didn't reach statistical significance doesn't mean that it was not a meaningful public-health impact." 

In Kentucky, there was no real difference in the adjusted rate of opioid-related overdose deaths between the intervention counties and the control-group counties, with 59.8 deaths per 100,000 residents in the intervention communities and 59.3 per 100,000 in the control communities. 

The study compared the control and intervention communities for one year, July 2021 through June 2022. 

"In retrospect, I think people will say that the 40% was a very ambitious goal," said Freeman. The researchers in the paper said likewise, adding, "The trial may have been underpowered to detect substantially smaller yet clinically meaningful differences."

An underpowered study does not have a sufficiently large sample size to answer the research question of interest," says the National Library of Medicine. 

The study, published June 16 in The New England Journal of Medicine, found no differences in estimated opioid-overdose deaths among the four states, nor any statistical differences between urban and rural communities, by age, by sex or among racial and ethnic groups. 

The research paper identifies several unforeseen challenges that likely diminished the impact of the interventions. Those include the Covid-19 pandemic, which began just two months after the start of the study’s intervention, an increase in the prevalence of fentanyl in illicit drug markets, and a 10-month implementation period, which may have been too short for communities to fully implement and see the effects of their efforts, says a UK news release.  

The four-year study, launched in 2019, included 67 communities affected by opioid abuse, including 16 Kentucky counties. UK  received $87 million from the National institutes of Health for the study, the largest competitive award UK has ever received. 

The other participants were Boston Medical Center in Massachusetts, Columbia University in New York City and Ohio State University. 

Freeman noted that the published study results don't reflect individual data for the 16 Kentucky counties, but the impact of the interventions in all 67 communities.  

The interventions involved increasing education about overdoses; increasing overdose-prevention education and distribution of the anti-overdose drug naloxone; increasing access to and retention of medications to treat opioid-use disorder, including methadone and buprenorphine; safer opioid prescribing, dispensing and disposal practices; and reducing the stigma of addiction.

 

"Specific efforts in Kentucky included partnering with 145 organizations to distribute more than 40,000 naloxone units," the news release says. "Strategies to help people find and stay in treatment deployed 26 peer-recovery coaches and 16 care navigators and provided $411,848 in transportation support.

"Other activities included partnering with 35 pharmacies to install permanent medication-disposal drop boxes, which has resulted in the incineration of more than 6,500 pounds of leftover medication. Efforts to reduce stigma and increase awareness of treatment resources produced 64 communication campaigns, resulting in 73 million engagements."

The study's principal investigator, Sharon Walsh, a professor in the College of Medicine and College of Pharmacy and director of the UK Center on Drug and Alcohol Research, said in the release, “Our findings demonstrate that implementing these evidence-based practices through community-engaged strategies and partnerships can make a meaningful impact on combating overdoses, even amid the rapidly evolving opioid epidemic and unprecedented disruptions like the Covid-19 pandemic,”  

Freeman said reserachers are continuing to analyze the data to look at the impact of each strategy used in the study, and have written paper that is under peer review, looking at how naloxone distribution changed in the intervention and control communities.

She said they will also continue to analyze the impact of the interventions on non-fatal overdoses, the impact on overdoses that involved opioids and other substances, since this study was specific to opioids, among other things.

Also coming are results from the control communities, which received the interventions after the comparisons between the control communities and intervention communities were complete.

"We'll be trying to really understand what were the strategies that were the most impactful in our communities," Freeman said. 

Looking forward, Freeman said she thought Kentucky could see some long-term benefits from this study because of the infrastructure, technical assistance and training that was set up with the agencies and organizations to implement the study. "I'm interested to see what's going to be a longer term impact," she said. 

The good news is that Kentucky has experienced two years of declines in overdose deaths. In  2022, it was one of only eight states that saw a decrease in drug overdose deaths, and in 2023, it saw a 10% drop in such deaths, according to the state's Office of Drug Control Policy.

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