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Showing posts with label controlled substances. Show all posts
Showing posts with label controlled substances. Show all posts

Wednesday, May 15, 2013

Could Medicare Part D be an inadvertent enabler of prescription drug abuse?

By Molly Burchett
Kentucky Health News

An examination of the Medicare Part D program that Congress established a decade ago, dedicating billions of dollars to subsidizing prescription drug purchases for 35 million elderly and disabled Americans, uncovers the program's risky lack of oversight -- and suggests that it might be contributing to Kentucky's prescription-drug abuse epidemic.

An analysis of Medicare prescription records by ProPublica, an independent, nonprofit newsroom, found that the program has failed to properly monitor safety, ProPublica's Tracy Weber, Charles Ornstein and Jennifer LaFleur write in The Washington Post. And despite their findings that many providers prescribe antipsychotics, narcotics and other drugs known to be dangerous for older adults, Medicare officials told them it's not their job to monitor for unsafe prescribing or to stop doctors with criminal histories.

The largely unchecked prescribing habits of Medicare providers and the increased availability of prescription drugs suggests that Part D has inadvertently enabled prescription drug abuse, by making drugs available for abuse by Medicare patients, their friends, acquaintances and family members, particularly teenagers. A 2010 national survey by the U.S. Department of Health and Human Services found that 65 percent of teens who report that they have abused prescription medicine got them from friends, family and acquaintances rather than illegal drug dealers.

In Kentucky, drug overdose, mostly from prescription drugs, is the leading cause of death, and the widespread availability of drugs and easy access to drugs are some reasons for this trend, says the 2012 combined report from the Kentucky Justice & Public Safety Cabinet. In addition to taking the lives of loved ones, drug overdose takes a huge financial toll on the state, and a recent study shows that the Medicare program bankrolls the single largest percentage of drug overdose inpatient hospitalizations.

Inpatient hospitalizations for drug overdoses by percentage of total charges,
among Kentucky residents treated in Kentucky acute-care hospitals, 2010
Medicare alone was billed for 30 percent of all inpatient hospitalizations for drug overdoses in Kentucky from 2000 through 2010, totaling over $440.7 million, says a report by the Kentucky Injury Prevention Research Center. During those 11 years, the number of unintentional drug-overdose hospitalizations of Medicare beneficiaries increased 222 percent.

The fact that almost a third of overdose hospitalizations involve Medicare patients is concerning, said Van Ingram, executive director for the Kentucky Office of Drug Control Policy. In addition to these alarming statistics, Medicare and Medicaid incurred nearly $4 million worth of charges for drug-overdose visits to emergency rooms in 2010, which represents 41 percent of the total charges, says the KIPRC report. Also, during the period from 2008 to 2010, the number of unintentional Medicare drug-overdose emergency visits increased almost 44 percent.

Among prescription drugs, opiates and similar narcotics are most likely to be abused and most likely to lead to death. Since Medicare Part D began covering prescription drugs in 2006, drug overdose deaths involving opiates have increased almost 80 percent in Kentucky, says the KIPRC report.

ProPublica's Prescriber Checkup database shows that 30 percent of Medicare Part D patients have filled at least one narcotic prescription. The most common drug provided by Part D in Kentucky is hydrocodone-aceteminophen, which is an opiate painkiller known commercially as Lortab, Lorcet or Vicodin. Part D paid more than $12.6 million on 958,933 claims for hydrocodone-aceteminophen from 2007 to 2010.

Medicare officials told ProPublica that the government isn't responsible for monitoring these types of prescriptions because that is the duty of private health plans administering the program. Yet, health plans aren't given the tools to do so, the reporters write, and no one party has been slated the task of ensuring safe medication-use. This complacent mentality suggests Medicare officials, who also say it's not the providers' duty to "prevent inappropriate prescribing for individual patients," could be passively contributing to the drug-safety issue of prescription medications covered by Part D.

In addition to indicating that providers should not industriously discourage dangerous prescription drug usage, ProPublica’s examination of Part D data showcases numerous examples of Medicare officials failing to act against providers with troubled prescribing backgrounds. Such examination initiates a worthwhile discussion about the program's role in encouraging, or well, at least not actively combating, prescription drug abuse. Click here to visit Kentucky's Medicare Part D Prescriber Checkup. Individual doctors can be looked up.
By Molly Burchett
Kentucky Health News

An examination of the Medicare Part D program that Congress established a decade ago, dedicating billions of dollars to subsidizing prescription drug purchases for 35 million elderly and disabled Americans, uncovers the program's risky lack of oversight -- and suggests that it might be contributing to Kentucky's prescription-drug abuse epidemic.

An analysis of Medicare prescription records by ProPublica, an independent, nonprofit newsroom, found that the program has failed to properly monitor safety, ProPublica's Tracy Weber, Charles Ornstein and Jennifer LaFleur write in The Washington Post. And despite their findings that many providers prescribe antipsychotics, narcotics and other drugs known to be dangerous for older adults, Medicare officials told them it's not their job to monitor for unsafe prescribing or to stop doctors with criminal histories.

The largely unchecked prescribing habits of Medicare providers and the increased availability of prescription drugs suggests that Part D has inadvertently enabled prescription drug abuse, by making drugs available for abuse by Medicare patients, their friends, acquaintances and family members, particularly teenagers. A 2010 national survey by the U.S. Department of Health and Human Services found that 65 percent of teens who report that they have abused prescription medicine got them from friends, family and acquaintances rather than illegal drug dealers.

In Kentucky, drug overdose, mostly from prescription drugs, is the leading cause of death, and the widespread availability of drugs and easy access to drugs are some reasons for this trend, says the 2012 combined report from the Kentucky Justice & Public Safety Cabinet. In addition to taking the lives of loved ones, drug overdose takes a huge financial toll on the state, and a recent study shows that the Medicare program bankrolls the single largest percentage of drug overdose inpatient hospitalizations.

Inpatient hospitalizations for drug overdoses by percentage of total charges,
among Kentucky residents treated in Kentucky acute-care hospitals, 2010
Medicare alone was billed for 30 percent of all inpatient hospitalizations for drug overdoses in Kentucky from 2000 through 2010, totaling over $440.7 million, says a report by the Kentucky Injury Prevention Research Center. During those 11 years, the number of unintentional drug-overdose hospitalizations of Medicare beneficiaries increased 222 percent.

The fact that almost a third of overdose hospitalizations involve Medicare patients is concerning, said Van Ingram, executive director for the Kentucky Office of Drug Control Policy. In addition to these alarming statistics, Medicare and Medicaid incurred nearly $4 million worth of charges for drug-overdose visits to emergency rooms in 2010, which represents 41 percent of the total charges, says the KIPRC report. Also, during the period from 2008 to 2010, the number of unintentional Medicare drug-overdose emergency visits increased almost 44 percent.

Among prescription drugs, opiates and similar narcotics are most likely to be abused and most likely to lead to death. Since Medicare Part D began covering prescription drugs in 2006, drug overdose deaths involving opiates have increased almost 80 percent in Kentucky, says the KIPRC report.

ProPublica's Prescriber Checkup database shows that 30 percent of Medicare Part D patients have filled at least one narcotic prescription. The most common drug provided by Part D in Kentucky is hydrocodone-aceteminophen, which is an opiate painkiller known commercially as Lortab, Lorcet or Vicodin. Part D paid more than $12.6 million on 958,933 claims for hydrocodone-aceteminophen from 2007 to 2010.

Medicare officials told ProPublica that the government isn't responsible for monitoring these types of prescriptions because that is the duty of private health plans administering the program. Yet, health plans aren't given the tools to do so, the reporters write, and no one party has been slated the task of ensuring safe medication-use. This complacent mentality suggests Medicare officials, who also say it's not the providers' duty to "prevent inappropriate prescribing for individual patients," could be passively contributing to the drug-safety issue of prescription medications covered by Part D.

In addition to indicating that providers should not industriously discourage dangerous prescription drug usage, ProPublica’s examination of Part D data showcases numerous examples of Medicare officials failing to act against providers with troubled prescribing backgrounds. Such examination initiates a worthwhile discussion about the program's role in encouraging, or well, at least not actively combating, prescription drug abuse. Click here to visit Kentucky's Medicare Part D Prescriber Checkup. Individual doctors can be looked up.
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Monday, January 28, 2013

Prescription-painkiller epidemic is spurred by societal shift, experts say: People think every problem has a pill for an answer

By Molly Burchett
Kentucky Health News

The prescription-painkiller epidemic stems partly from an evolution of society's views toward pain and how to deal with it, said experts at "The Different Faces of Substance Abuse" conference in Lexington Jan. 23-24.

"The entire society's viewpoint of pain and the management of pain has completed shifted," said Dr. Ryan Stanton, an emergency physician and conference panelist.

Pain is considered the fifth vital sign, after temperature, pulse, blood pressure and respiratory rate, but it is the only sign that is subjective, which complicates the problem, said Stanton, because patient satisfaction is associated with the amount of drugs the provider prescribes. If an emergency-room doctor suggests exercise to combat back pain, he said the patient's reaction might be, "You might as well ask a man to deliver a baby."

The substance-abuse problem shouldn't be laid at the feet of prescribers because patients think there is a pill out there for every problem when sometimes the answer is non-prescription ibubrofen and an ice pack, said Van Ingram, executive director of the state Office of Drug Control Policy.

"This is a complicated issue," Ingram said. "It's easy to be against heroin, and it's easy to be against cocaine. But prescription opioids are things that many people need to live and need to improve their quality of life at the end of life."

Patients need to understand how much a doctor can or should do, said Dr. Helen Davis, conference panelist and chair of the Gov. Steve Beshear's KASPER Advisory Council. "Patients come in to the doctor's office expecting a silver bullet . . . but when looking at pain, the goal isn't to make the patient pain-free," she said. "The goal is to reduce the pain enough that they can have systematic and functional relief to go about their daily living."

Davis said doctors and nurses must change their culture to become more collaborative with the patient to address the non-pharmacological management of pain. There are some things that are the responsibility of the provider and there are some things that are the patients', families' and communities' responsibility, she said, adding that all professionals must look at their interdisciplinary responsibility to the people of the state.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

By Molly Burchett
Kentucky Health News

The prescription-painkiller epidemic stems partly from an evolution of society's views toward pain and how to deal with it, said experts at "The Different Faces of Substance Abuse" conference in Lexington Jan. 23-24.

"The entire society's viewpoint of pain and the management of pain has completed shifted," said Dr. Ryan Stanton, an emergency physician and conference panelist.

Pain is considered the fifth vital sign, after temperature, pulse, blood pressure and respiratory rate, but it is the only sign that is subjective, which complicates the problem, said Stanton, because patient satisfaction is associated with the amount of drugs the provider prescribes. If an emergency-room doctor suggests exercise to combat back pain, he said the patient's reaction might be, "You might as well ask a man to deliver a baby."

The substance-abuse problem shouldn't be laid at the feet of prescribers because patients think there is a pill out there for every problem when sometimes the answer is non-prescription ibubrofen and an ice pack, said Van Ingram, executive director of the state Office of Drug Control Policy.

"This is a complicated issue," Ingram said. "It's easy to be against heroin, and it's easy to be against cocaine. But prescription opioids are things that many people need to live and need to improve their quality of life at the end of life."

Patients need to understand how much a doctor can or should do, said Dr. Helen Davis, conference panelist and chair of the Gov. Steve Beshear's KASPER Advisory Council. "Patients come in to the doctor's office expecting a silver bullet . . . but when looking at pain, the goal isn't to make the patient pain-free," she said. "The goal is to reduce the pain enough that they can have systematic and functional relief to go about their daily living."

Davis said doctors and nurses must change their culture to become more collaborative with the patient to address the non-pharmacological management of pain. There are some things that are the responsibility of the provider and there are some things that are the patients', families' and communities' responsibility, she said, adding that all professionals must look at their interdisciplinary responsibility to the people of the state.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Experts explain changes to state prescription-tracking system

By Molly Burchett
Kentucky Health News

The Kentucky All-Schedule Prescription Electronic Reporting system, the key to fighting doctor-shopping for painkillers in the state, has undergone several changes since the legislature passed House Bill 1 last year to crack down on so-called pill mills. An expert panel at "The Different Faces of Substance Abuse"conference last week in Lexington addressed the more recent changes to KASPER.

“The new legislation has brought prescription drug use into the medical arena when it had not been before,” said Dr. Michelle Lofwall, member of the KASPER Advisory Council, created last year by Gov. Steve Beshear.

Very soon Kentucky will be sharing KASPER data with all seven border states, which will be provided automatically in reports, and all agreements to enable this exchange have already been signed, said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

One important but little-reported change is that KASPER reports can now be included in patients’ medical records. Prior to the passage of HB1, this was a felony and created workflow problems for physicians.

Attorney General Jack Conway has steered money from a mortgage settlement to enable the necessary system upgrades to KASPER that will bring about additional changes, said Ingram. Starting in July, dispensers of drugs will be required to report data every 24 hours instead of the current weekly timeframe, improving the timeliness of the data.

Changes are also coming to the regulations associated with HB1, since medical licensure boards have “gotten an earful” and have revisited the regulations to make them more straightforward and common sense, KASPER program manager Dave Hopkins said.

Ingram said, “With any big policy change, there are going to be unintended consequences. . . . The legislature will take a look at the unintended consequences. If you want to make drastic changes, it’s going to be chaos for a while.”

“In a lot of things with government, great ideas are complicated by reality,” said Dr. Ryan Stanton, UK Good Samaritan Hospital emergency-room physician and medical director, as he painted a more realistic picture of KASPER from when he first created an account with the system in 2005.

Stanton said recent changes have included timelier and more accurate reports that make the system easier to use. He said more such improvements are critical to catch those who "abuse in spurts," and are also important because physicians have minimal time and need to spend more time with patients instead of in front of a computer.

The use of KASPER has increased significantly since the passage of HB 1, with the number of reports requested increasing from 811,000 in 2011 to 2.69 million in 2012.

Medications containing the painkiller hydrocodone, including Lortab, Lorcet and Vicodin, remain the most-prescribed type of controlled substance in Kentucky, 41.5 percent of the total.

Click here for more information about KASPER.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
By Molly Burchett
Kentucky Health News

The Kentucky All-Schedule Prescription Electronic Reporting system, the key to fighting doctor-shopping for painkillers in the state, has undergone several changes since the legislature passed House Bill 1 last year to crack down on so-called pill mills. An expert panel at "The Different Faces of Substance Abuse"conference last week in Lexington addressed the more recent changes to KASPER.

“The new legislation has brought prescription drug use into the medical arena when it had not been before,” said Dr. Michelle Lofwall, member of the KASPER Advisory Council, created last year by Gov. Steve Beshear.

Very soon Kentucky will be sharing KASPER data with all seven border states, which will be provided automatically in reports, and all agreements to enable this exchange have already been signed, said Van Ingram, executive director of the Kentucky Office of Drug Control Policy.

One important but little-reported change is that KASPER reports can now be included in patients’ medical records. Prior to the passage of HB1, this was a felony and created workflow problems for physicians.

Attorney General Jack Conway has steered money from a mortgage settlement to enable the necessary system upgrades to KASPER that will bring about additional changes, said Ingram. Starting in July, dispensers of drugs will be required to report data every 24 hours instead of the current weekly timeframe, improving the timeliness of the data.

Changes are also coming to the regulations associated with HB1, since medical licensure boards have “gotten an earful” and have revisited the regulations to make them more straightforward and common sense, KASPER program manager Dave Hopkins said.

Ingram said, “With any big policy change, there are going to be unintended consequences. . . . The legislature will take a look at the unintended consequences. If you want to make drastic changes, it’s going to be chaos for a while.”

“In a lot of things with government, great ideas are complicated by reality,” said Dr. Ryan Stanton, UK Good Samaritan Hospital emergency-room physician and medical director, as he painted a more realistic picture of KASPER from when he first created an account with the system in 2005.

Stanton said recent changes have included timelier and more accurate reports that make the system easier to use. He said more such improvements are critical to catch those who "abuse in spurts," and are also important because physicians have minimal time and need to spend more time with patients instead of in front of a computer.

The use of KASPER has increased significantly since the passage of HB 1, with the number of reports requested increasing from 811,000 in 2011 to 2.69 million in 2012.

Medications containing the painkiller hydrocodone, including Lortab, Lorcet and Vicodin, remain the most-prescribed type of controlled substance in Kentucky, 41.5 percent of the total.

Click here for more information about KASPER.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
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Friday, October 26, 2012

More child-welfare indicators added to Kids Count data site

Kentucky Youth Advocates has added four new child welfare indicators to the agency's Kids Count Data Center. These four new indicators provide Kentuckians and those who report on them with more information on vulnerable children and families in the state.

One new indicator shows the prevalence of certain risk factors -- substance abuse, mental health issues, and income -- in cases where child abuse or neglect was found to have occurred after an investigation was done. Another new indicator include the numbers of children community members bring to the attention of the state Department for Community Based Services due to suspicions of child abuse or neglect. (Read more)

Kids Count provides information across states and for Kentucky counties and school districts on many measures of child well-being, including economic well-being, education, health, and safety. To find the data center, go here.


Kentucky Youth Advocates has added four new child welfare indicators to the agency's Kids Count Data Center. These four new indicators provide Kentuckians and those who report on them with more information on vulnerable children and families in the state.

One new indicator shows the prevalence of certain risk factors -- substance abuse, mental health issues, and income -- in cases where child abuse or neglect was found to have occurred after an investigation was done. Another new indicator include the numbers of children community members bring to the attention of the state Department for Community Based Services due to suspicions of child abuse or neglect. (Read more)

Kids Count provides information across states and for Kentucky counties and school districts on many measures of child well-being, including economic well-being, education, health, and safety. To find the data center, go here.


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Monday, August 20, 2012

Some doctors find law to fight pill mills confusing and overreaching, and some say they will stop writing prescriptions

Dr. Kathy Nieder, with patient charts
(C-J photo by Michael Clevenger)
Dr. Ralph Alvarado’s medical practice in Winchester has prescribed controlled substances to 1,800 patients in Central Kentucky over the past three years. But he and other doctors in the practice decided to put down their pens four weeks ago. That’s because, Mike Wynn of The Courier-Journal reports, "The standards imposed under a new Kentucky law designed to crack down on prescription drug abuse are so strict and complex that he would go bankrupt in a month -- or worse -- if he were to continue prescribing controlled substances."

Alvarado, who has made two unsuccessful campaigns for the state Senate, told Wynn, "I’m not going to be threatened with jail time or criminal charges and lose my career." He said he would refer patients to specialists to get pain-pill prescriptions.

Proponents argue that the new prescribing standards in House Bill 1, passed by the 2012 General Assembly "in hopes of combating an epidemic of drug abuse that kills nearly 1,000 Kentuckians each year were intended only to root out pill mills and crooked doctors and should not hamper legitimate physicians or prevent patients from receiving needed drugs," Wynn writes. However, "Some doctors contend the legislation is excessive, confusing and time-consuming, and across Kentucky, many have been seeking advice from attorneys about following the law, and warning patients about potential cutbacks to common drugs for pain, anxiety and other conditions. Some doctors are even talking about leaving the state. . . . Others say they have sent patients home in tears or in pain because they lack the time and resources to comply with the law."

"Patients who have never been a problem are bound up in all of this," Greg Hood, Kentucky chapter governor of the American College of Physicians, told Wynn. "There are so many unintended consequences." Hood's group and the Kentucky Medical Association are trying to determine how many clinics are declining to write prescriptions, but neither is advocating that approach. According to state offices of the Drug Enforcement Administration, only three in-state doctors have voluntarily surrendered their DEA registration — required for prescribing controlled substances — in recent weeks for reasons related to the new law. Still, the Greater Louisville Medical Society held a meeting with about 200 members recently in which attorneys tried to explain the law’s details. Doctors cited nearly two dozen areas of concern stemming from what they call vague and ambiguous legal language, the group reported. (Read more)

Dr. Kathy Nieder, with patient charts
(C-J photo by Michael Clevenger)
Dr. Ralph Alvarado’s medical practice in Winchester has prescribed controlled substances to 1,800 patients in Central Kentucky over the past three years. But he and other doctors in the practice decided to put down their pens four weeks ago. That’s because, Mike Wynn of The Courier-Journal reports, "The standards imposed under a new Kentucky law designed to crack down on prescription drug abuse are so strict and complex that he would go bankrupt in a month -- or worse -- if he were to continue prescribing controlled substances."

Alvarado, who has made two unsuccessful campaigns for the state Senate, told Wynn, "I’m not going to be threatened with jail time or criminal charges and lose my career." He said he would refer patients to specialists to get pain-pill prescriptions.

Proponents argue that the new prescribing standards in House Bill 1, passed by the 2012 General Assembly "in hopes of combating an epidemic of drug abuse that kills nearly 1,000 Kentuckians each year were intended only to root out pill mills and crooked doctors and should not hamper legitimate physicians or prevent patients from receiving needed drugs," Wynn writes. However, "Some doctors contend the legislation is excessive, confusing and time-consuming, and across Kentucky, many have been seeking advice from attorneys about following the law, and warning patients about potential cutbacks to common drugs for pain, anxiety and other conditions. Some doctors are even talking about leaving the state. . . . Others say they have sent patients home in tears or in pain because they lack the time and resources to comply with the law."

"Patients who have never been a problem are bound up in all of this," Greg Hood, Kentucky chapter governor of the American College of Physicians, told Wynn. "There are so many unintended consequences." Hood's group and the Kentucky Medical Association are trying to determine how many clinics are declining to write prescriptions, but neither is advocating that approach. According to state offices of the Drug Enforcement Administration, only three in-state doctors have voluntarily surrendered their DEA registration — required for prescribing controlled substances — in recent weeks for reasons related to the new law. Still, the Greater Louisville Medical Society held a meeting with about 200 members recently in which attorneys tried to explain the law’s details. Doctors cited nearly two dozen areas of concern stemming from what they call vague and ambiguous legal language, the group reported. (Read more)

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Wednesday, July 25, 2012

Bath salts, synthetic drugs change too fast for foes to fight

Bath salts, which mimic the effects of drugs like cocaine
and speed. The Patriot-News photo by Chris Knight.
Though legislators across the country, including Kentucky, have passed laws to ban synthetic drugs like bath salts, there are so many new formulations of the substances the states can't keep up.

Experts estimate there are more than 100 types of bath-salt chemicals. "The moment you start to regulate one of them, they'll come out with a variant that sometimes is even more potent," said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

The drugs, which mimic the effects of drugs like cocaine and amphetamines, are usually sold at small stores "in misleading packaging that suggests common household items like bath salts, incense and plant food," Matthew Perrone reports for The Associated Press. "But the substances inside are powerful, mind-altering drugs that have been linked to bizarre and violent behavior across the country." The products are sold under brand names like "Ivory Wave," "Vanilla Sky" and "Bliss." The American Association of Poison Control got more than 6,100 calls about the drugs in 2011 — up from 304 in 2010 — and 1,700 calls so far this year.

The sticky wicket in controlling the surge of formulations stems from the fact that "U.S. laws prohibit the sale or possession of all substances that mimic illegal drugs, but only if federal prosecutors can show that they are intended for human use," Perrone reports. On almost every packet of these drugs, there is a warning that says they are not fit for human consumption. Be that as it may, "everyone knows these are drugs to get high, including the sellers," said Barbara Carreno, a spokeswoman for the Drug Enforcement Administration.

Kentucky banned bath salts in 2011. In May 2012 Gov. Steve Beshear signed a mandate that "closes legal loopholes by banning classes, not just compounds, of synthetic drugs," reports Jeffery Smith for WFIE-TV in Evansville, Ind. The 2011 law "extends seizure and forfeiture laws to retailers who sell the items, makes sales a felony for a second or subsequent offense, and makes simple possession a misdemeanor," Smith reports.

Still, those fighting on the front lines of the problem said it's difficult to curb. "The problem is these drugs are changing and I'm sure they're going to find some that are a little bit different chemically so they don't fall under the law," said Dr. Sullivan Smith of Cookeville Regional Medical Center in Tennessee. "Is it adequate to name five or 10 or even 20? The answer is no, they're changing too fast." (Read more)

Bath salts, which mimic the effects of drugs like cocaine
and speed. The Patriot-News photo by Chris Knight.
Though legislators across the country, including Kentucky, have passed laws to ban synthetic drugs like bath salts, there are so many new formulations of the substances the states can't keep up.

Experts estimate there are more than 100 types of bath-salt chemicals. "The moment you start to regulate one of them, they'll come out with a variant that sometimes is even more potent," said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

The drugs, which mimic the effects of drugs like cocaine and amphetamines, are usually sold at small stores "in misleading packaging that suggests common household items like bath salts, incense and plant food," Matthew Perrone reports for The Associated Press. "But the substances inside are powerful, mind-altering drugs that have been linked to bizarre and violent behavior across the country." The products are sold under brand names like "Ivory Wave," "Vanilla Sky" and "Bliss." The American Association of Poison Control got more than 6,100 calls about the drugs in 2011 — up from 304 in 2010 — and 1,700 calls so far this year.

The sticky wicket in controlling the surge of formulations stems from the fact that "U.S. laws prohibit the sale or possession of all substances that mimic illegal drugs, but only if federal prosecutors can show that they are intended for human use," Perrone reports. On almost every packet of these drugs, there is a warning that says they are not fit for human consumption. Be that as it may, "everyone knows these are drugs to get high, including the sellers," said Barbara Carreno, a spokeswoman for the Drug Enforcement Administration.

Kentucky banned bath salts in 2011. In May 2012 Gov. Steve Beshear signed a mandate that "closes legal loopholes by banning classes, not just compounds, of synthetic drugs," reports Jeffery Smith for WFIE-TV in Evansville, Ind. The 2011 law "extends seizure and forfeiture laws to retailers who sell the items, makes sales a felony for a second or subsequent offense, and makes simple possession a misdemeanor," Smith reports.

Still, those fighting on the front lines of the problem said it's difficult to curb. "The problem is these drugs are changing and I'm sure they're going to find some that are a little bit different chemically so they don't fall under the law," said Dr. Sullivan Smith of Cookeville Regional Medical Center in Tennessee. "Is it adequate to name five or 10 or even 20? The answer is no, they're changing too fast." (Read more)

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