Kentucky's pill-mill problem and law to fight it get national airing, with issues of patient privacy versus public health debated

Kentucky's "pill problem" went more public Thursday when David Hopkins, head of the state's prescription drug monitoring program, told the National Conference of State Legislatures the true extent of our prescription pain pill addiction. Maggie Clark of Stateline reports that lawmakers "shook their heads in disbelief" when Hopkins said the state's doctors issued 60 million prescriptions for the 4.4 million Kentuckians in August of this year alone. The stark admission was a way to start talking about where patient privacy ends and public health concerns begin, Clark writes.

Kentucky is among 42 states with operational prescription-monitoring laws but few others require physicians to use the database to chronicle each patient and their drug use before prescribing as Kentucky does. And while the commonwealth allows its law-enforcement officers access to the database, the database is not controlled by the attorney general's office but, as a nod to patient privacy, by the Cabinet for Health and Family Services. In Vermont, legislators fought that battle earlier this year, with police there needing a warrant to access it. When Kentucky's law enforcement officers were surveyed about the law in 2010, 73 percent said they found the tool "excellent" for obtaining evidence.

At the conference, a report citing a Centers for Disease Control review explained that data collected through 2005 in a limited number of studies shows that having a prescription drug monitoring program in place had no clear impact on overdose mortality, Clark reports.

Kentucky's "pill problem" went more public Thursday when David Hopkins, head of the state's prescription drug monitoring program, told the National Conference of State Legislatures the true extent of our prescription pain pill addiction. Maggie Clark of Stateline reports that lawmakers "shook their heads in disbelief" when Hopkins said the state's doctors issued 60 million prescriptions for the 4.4 million Kentuckians in August of this year alone. The stark admission was a way to start talking about where patient privacy ends and public health concerns begin, Clark writes.

Kentucky is among 42 states with operational prescription-monitoring laws but few others require physicians to use the database to chronicle each patient and their drug use before prescribing as Kentucky does. And while the commonwealth allows its law-enforcement officers access to the database, the database is not controlled by the attorney general's office but, as a nod to patient privacy, by the Cabinet for Health and Family Services. In Vermont, legislators fought that battle earlier this year, with police there needing a warrant to access it. When Kentucky's law enforcement officers were surveyed about the law in 2010, 73 percent said they found the tool "excellent" for obtaining evidence.

At the conference, a report citing a Centers for Disease Control review explained that data collected through 2005 in a limited number of studies shows that having a prescription drug monitoring program in place had no clear impact on overdose mortality, Clark reports.

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CDC: Kentucky grossly underuses tobacco settlement money when it comes to tobacco prevention and cessation programs

Kentucky is not even remotely up to snuff on state tobacco-prevention programming. According to a new report from the Robert Wood Johnson Foundation and the Centers for Disease Control, the state spends only $2.2 million on such programs. That amount is only 4.5 percent of what the CDC recommends that state, which has the highest incidence of tobacco use in the nation, spend. If the state spent what the nation's most prestigious health institution recommended, state spending to improve Kentucky's collective lungs should be in the $57 million range.

Kentucky ranks 36th in state tobacco control spending nationwide. According to the RWJ Foundation report, states will collect a record $25.7 billion in revenue from the tobacco settlement and from tobacco taxes this year, but will spend just 1.8 percent of that money on programs to prevent kids from smoking and help smokers quit. That's less than two cents of every tobacco dollar sent back to the states. Only Alaska and North Dakota are funding the levels that the CDC has recommended.

Read the report here. To view an interactive national map, with each state's spending outlined at here.

Kentucky is not even remotely up to snuff on state tobacco-prevention programming. According to a new report from the Robert Wood Johnson Foundation and the Centers for Disease Control, the state spends only $2.2 million on such programs. That amount is only 4.5 percent of what the CDC recommends that state, which has the highest incidence of tobacco use in the nation, spend. If the state spent what the nation's most prestigious health institution recommended, state spending to improve Kentucky's collective lungs should be in the $57 million range.

Kentucky ranks 36th in state tobacco control spending nationwide. According to the RWJ Foundation report, states will collect a record $25.7 billion in revenue from the tobacco settlement and from tobacco taxes this year, but will spend just 1.8 percent of that money on programs to prevent kids from smoking and help smokers quit. That's less than two cents of every tobacco dollar sent back to the states. Only Alaska and North Dakota are funding the levels that the CDC has recommended.

Read the report here. To view an interactive national map, with each state's spending outlined at here.

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CDC director: Flu season is three weeks early, could be a bad one

Prepare for a bad flu season. According to the Centers for Disease Control, this flu season seems to be ahead of schedule if you use the last decade as any judge of when the season should begin, which is usually around Christmas. Suspected cases have already showed up in Alabama, Louisiana, Florida, Mississippi, Tennessee and Texas, with two infant deaths already having been reported. (Getty Images)

Dr. Thomas Frieden, CDC director, sees good news in that fact that the nation seems well prepared this year. He told the Associated Press that more than a third of Americans have been vaccinated and that the vaccine is well matched to the strains of flu seen so far. (Read more)

Prepare for a bad flu season. According to the Centers for Disease Control, this flu season seems to be ahead of schedule if you use the last decade as any judge of when the season should begin, which is usually around Christmas. Suspected cases have already showed up in Alabama, Louisiana, Florida, Mississippi, Tennessee and Texas, with two infant deaths already having been reported. (Getty Images)

Dr. Thomas Frieden, CDC director, sees good news in that fact that the nation seems well prepared this year. He told the Associated Press that more than a third of Americans have been vaccinated and that the vaccine is well matched to the strains of flu seen so far. (Read more)

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Study: Teenagers may buy fewer cigarettes if the product is not prominently displayed

For Kentucky which has the dubious distinction of having the nation's highest rate of teen smokers, an study published this week in Pediatrics reports that teenagers may be less likely to buy cigarettes at convenience stores if they aren't sold in plain sight. Genevra Pittman of Reuters Health explains that requiring stores to hide tobacco product displays is one option some states are considering to curb teen smoking after the Family Smoking Prevention and Tobacco Control Act of 2009 was passed, according to Annice Kim, the study's lead author. No state has yet banned the displays. (Associated Press photo)

The study was conducted using a virtual reality game where teens, ages 13 to 17, "visited" simulated stores to purchase items. In some cases, the cigarettes were displayed behind the counter; in others, they were covered up. The researchers from RTI International found that 16 to 24 percent of teens tried to buy tobacco when the display was open, compared to 9 to 11 percent when it was closed. Thirty-two percent said they were aware cigarettes were available when the display case was closed , compared to 85 percent of those who had the open version.

Dr. Michael Siegel, of the Boston University School of Public Health, told Pittman that the study was interesting but he was skeptical of extrapolating it into real life. Real life kids, he said, will go to a store when they want to buy cigarettes. "I don't know how many situations there are when a kid is hanging out in a convenience store with nothing to do and says, 'Oh, I'll just try a cigarette as long as they're here.' "(Read more)

For Kentucky which has the dubious distinction of having the nation's highest rate of teen smokers, an study published this week in Pediatrics reports that teenagers may be less likely to buy cigarettes at convenience stores if they aren't sold in plain sight. Genevra Pittman of Reuters Health explains that requiring stores to hide tobacco product displays is one option some states are considering to curb teen smoking after the Family Smoking Prevention and Tobacco Control Act of 2009 was passed, according to Annice Kim, the study's lead author. No state has yet banned the displays. (Associated Press photo)

The study was conducted using a virtual reality game where teens, ages 13 to 17, "visited" simulated stores to purchase items. In some cases, the cigarettes were displayed behind the counter; in others, they were covered up. The researchers from RTI International found that 16 to 24 percent of teens tried to buy tobacco when the display was open, compared to 9 to 11 percent when it was closed. Thirty-two percent said they were aware cigarettes were available when the display case was closed , compared to 85 percent of those who had the open version.

Dr. Michael Siegel, of the Boston University School of Public Health, told Pittman that the study was interesting but he was skeptical of extrapolating it into real life. Real life kids, he said, will go to a store when they want to buy cigarettes. "I don't know how many situations there are when a kid is hanging out in a convenience store with nothing to do and says, 'Oh, I'll just try a cigarette as long as they're here.' "(Read more)

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British researchers say a simple calculation can predict likelihood of a baby's chance of becoming obese during childhood

If only we knew from the start which babies were predisposed to becoming diabetic and hypertensive and overweight . . . News out this week suggests we can. NBC News reports that British researchers have published findings in the journal PLOS ONE saying that a simple assessment can predict at birth a baby's likelihood of becoming obese during childhood. The formula, available as an online calculator here, estimates the child's obesity risk based on its birth weight, the body mass index of the parents, the number of people in the household, the mother's professional status and whether she smoked during pregnancy.

The hope is to help families will take steps to control the weight of babies and small children before medical problems arise. Philippe Froguel of Imperial College London, who led the study, explained that teaching parents about the dangers of over-feeding and bad nutritional habits at a young age is much more effective than having to teach children how to lose weight. Froguel's team developed their formula following 4,000 Finnish children since 1986. Childhood obesity is a leading cause of early type 2 diabetes, as well as various types of cardiovascular disease. (Read more)

If only we knew from the start which babies were predisposed to becoming diabetic and hypertensive and overweight . . . News out this week suggests we can. NBC News reports that British researchers have published findings in the journal PLOS ONE saying that a simple assessment can predict at birth a baby's likelihood of becoming obese during childhood. The formula, available as an online calculator here, estimates the child's obesity risk based on its birth weight, the body mass index of the parents, the number of people in the household, the mother's professional status and whether she smoked during pregnancy.

The hope is to help families will take steps to control the weight of babies and small children before medical problems arise. Philippe Froguel of Imperial College London, who led the study, explained that teaching parents about the dangers of over-feeding and bad nutritional habits at a young age is much more effective than having to teach children how to lose weight. Froguel's team developed their formula following 4,000 Finnish children since 1986. Childhood obesity is a leading cause of early type 2 diabetes, as well as various types of cardiovascular disease. (Read more)

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One S.C. county serves as incubator for state's efforts to battle weight problems, with some good results

PE teacher Sharon Williams, right,
leads morning exercises before
classes start at Bells Elementary.
(The State photo by Tim Dominick)

With nearly two-thirds of South Carolina deemed overweight or worse, lucky Colleton County got picked to be a test case for doing better. That is, for improving its chances to beat the state's already overwhelming rates of diabetes, heart disease and stroke and for helping to lower the state's $1.2 billion dollar medical bill. Lucky, because in 2010, the county was awarded almost a half million Eat Smart Move More grant by the BlueCross BlueShield of South Carolina Foundation to see if it could promote health eating and more physical exercise countywide. Joey Hollerman of The State newspaper in Columbia, S.C., reports that "the results have been striking," though he notes that changing obesity numbers is "like turning an aircraft carrier, it's a slow process." Mostly, he's talking about attitude and perseverance.

How does the county-wide program work on a daily basis? First, of course, you have to have buy-in, which this county did. Hollerman explains that now when children arrive at Bells Elementary School in the county seat of Walterboro, "they go straight to the gym and walk laps before heading to classrooms. Worshipers at Power of Faith Delivery Ministry harvest collards as well as souls, and fried chicken is discouraged at church dinners. The local farmers market has a sparkling new home and a system set up to accept cards from the Supplemental Nutrition Assistance Program." The Let’s Go, Eat Smart program and exercise programs are posted in schools, workplaces, grocery stores and churches.

So how, if the numbers aren't clear yet, how to measure if it's working? Well, only one fried chicken basket showed up at a recent church supper and the member who brought it ended up apologizing for her breach. On the day the reporter visited only the elementary school only one child in the entire first grade tried to slip through without selecting a fruit or vegetable. He was sent back and grabbed a plastic container of grapes from the Go (instead of the Slow or Whoa) food options, Hollerman reports. There are also anecdotes galore, including those of children, once on insulin, who are now fine without it.

South Carolin's BlueCross BlueShield recently awarded another grant to Eat Smart Move More, in part to continue the work in Colleton County but also to for expand it to other communities. (Read more)

PE teacher Sharon Williams, right,
leads morning exercises before
classes start at Bells Elementary.
(The State photo by Tim Dominick)

With nearly two-thirds of South Carolina deemed overweight or worse, lucky Colleton County got picked to be a test case for doing better. That is, for improving its chances to beat the state's already overwhelming rates of diabetes, heart disease and stroke and for helping to lower the state's $1.2 billion dollar medical bill. Lucky, because in 2010, the county was awarded almost a half million Eat Smart Move More grant by the BlueCross BlueShield of South Carolina Foundation to see if it could promote health eating and more physical exercise countywide. Joey Hollerman of The State newspaper in Columbia, S.C., reports that "the results have been striking," though he notes that changing obesity numbers is "like turning an aircraft carrier, it's a slow process." Mostly, he's talking about attitude and perseverance.

How does the county-wide program work on a daily basis? First, of course, you have to have buy-in, which this county did. Hollerman explains that now when children arrive at Bells Elementary School in the county seat of Walterboro, "they go straight to the gym and walk laps before heading to classrooms. Worshipers at Power of Faith Delivery Ministry harvest collards as well as souls, and fried chicken is discouraged at church dinners. The local farmers market has a sparkling new home and a system set up to accept cards from the Supplemental Nutrition Assistance Program." The Let’s Go, Eat Smart program and exercise programs are posted in schools, workplaces, grocery stores and churches.

So how, if the numbers aren't clear yet, how to measure if it's working? Well, only one fried chicken basket showed up at a recent church supper and the member who brought it ended up apologizing for her breach. On the day the reporter visited only the elementary school only one child in the entire first grade tried to slip through without selecting a fruit or vegetable. He was sent back and grabbed a plastic container of grapes from the Go (instead of the Slow or Whoa) food options, Hollerman reports. There are also anecdotes galore, including those of children, once on insulin, who are now fine without it.

South Carolin's BlueCross BlueShield recently awarded another grant to Eat Smart Move More, in part to continue the work in Colleton County but also to for expand it to other communities. (Read more)

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Cheaper heroin showing up in Eastern Kentucky as crackdown on pain pills makes that trade less attractive

About 60 grams of heroin, worth about
$8,000. (AP photo)

It was only few months ago that Northern Kentucky law enforcement officers and substance abuse clinics began expressing grave concern that heroin was fast becoming the go-to drug in their region. Today, there are signs that the drug is already moving swiftly east, into the already drug-ravaged mountains of Eastern Kentucky. The reason for the uptick in heroin use? Because pain pills aren't as available anymore.

Federal and state law enforcement have been cracking down on the prescription pain-pill drug trade for years in these parts. They've created electronic prescription-tracking systems, staked out pain management clinics and shut down a drug pipeline that starts in Florida. Some argue that last year's passage of House Bill 1 has discouraged even legitimate doctors from prescribing pain drugs. All these things make heroin usage an unintended consequence of their success, officials fear.

 "There's always some type of drug to step up when another gets taken out," Dan Smoot, law enforcement director of Operation UNITE, which handles drug investigations in 29 Eastern Kentucky counties, told Brett Barrouquere of The Associated Press. "We didn't know it was going to be heroin. We knew something was going to replace pills."

Officials say the heroin is trafficked from Mexico into the U.S., where it first goes to Illinois, Michigan and Ohio. Northern Kentucky counties have been the epicenter of heroin abuse in the state, but law enforcement officials in Louisville, Lexington and Appalachian counties are reporting "a dramatic rise in the number of arrests and seizures related" to heroin. Kentucky State Police seized 11 doses of heroin and other opiates in 2008 in the eastern half of the state; they have seized 395 doses there so far this year.

Users are attracted to heroin's low cost compared to pain pills, Barrouquere reports. A single oxycodone pill can cost from $80 to $100, but heroin can cost as little as $15 to $20 for an amount that will produce the same level of intoxication as one pain pill for 24 hours, Kentucky Office of Drug Control Policy Director Van Ingram said. (Read more)

About 60 grams of heroin, worth about
$8,000. (AP photo)

It was only few months ago that Northern Kentucky law enforcement officers and substance abuse clinics began expressing grave concern that heroin was fast becoming the go-to drug in their region. Today, there are signs that the drug is already moving swiftly east, into the already drug-ravaged mountains of Eastern Kentucky. The reason for the uptick in heroin use? Because pain pills aren't as available anymore.

Federal and state law enforcement have been cracking down on the prescription pain-pill drug trade for years in these parts. They've created electronic prescription-tracking systems, staked out pain management clinics and shut down a drug pipeline that starts in Florida. Some argue that last year's passage of House Bill 1 has discouraged even legitimate doctors from prescribing pain drugs. All these things make heroin usage an unintended consequence of their success, officials fear.

 "There's always some type of drug to step up when another gets taken out," Dan Smoot, law enforcement director of Operation UNITE, which handles drug investigations in 29 Eastern Kentucky counties, told Brett Barrouquere of The Associated Press. "We didn't know it was going to be heroin. We knew something was going to replace pills."

Officials say the heroin is trafficked from Mexico into the U.S., where it first goes to Illinois, Michigan and Ohio. Northern Kentucky counties have been the epicenter of heroin abuse in the state, but law enforcement officials in Louisville, Lexington and Appalachian counties are reporting "a dramatic rise in the number of arrests and seizures related" to heroin. Kentucky State Police seized 11 doses of heroin and other opiates in 2008 in the eastern half of the state; they have seized 395 doses there so far this year.

Users are attracted to heroin's low cost compared to pain pills, Barrouquere reports. A single oxycodone pill can cost from $80 to $100, but heroin can cost as little as $15 to $20 for an amount that will produce the same level of intoxication as one pain pill for 24 hours, Kentucky Office of Drug Control Policy Director Van Ingram said. (Read more)

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