Lawmakers hear sobering account of opioid crisis

September 21, 2017

Lawmakers hear sobering account of opioid crisis

FRANKFORT – At one Kentucky hospital, people are actually bringing in heroin and shooting up with patients.

That’s one example of the “very desperate situation” the opioid-abuse crisis has created, Kentucky Chamber of Commerce President Dave Adkisson said while testifying before a panel of state legislators yesterday in the Capitol Annex.

He was among more than 25 people from across the country who testified about the best policies to attack the crisis at a rare six-hour meeting of both the Interim Joint Committee on Health and Welfare and Family Services, and the Medicaid Oversight and Advisory Committee.

“Today is a snapshot,” meeting co-chair Rep. Addia Wuchner, R-Florence, said of the topics on the agenda that included prevention, treatment and criminal justice issues.

Co-chair Rep. Kimberly Poore Moser, R-Taylor Mill, said the point of combining the two committees’ meetings was to show the complexity of the opioid-abuse crisis and need for a coordinated, long-term strategy to tackle it.

“We know that everything we have heard about the opioid use disorder problem, heroin problem, is real to many families and our communities,” she said, “and it cuts across all demographics. It touches everyone. We know it doesn’t matter where you live. Addiction doesn’t care how smart you are, where you went to school or how much money you make.”

Office of Drug Control Policy Executive Director Van Ingram testified that 1,404 Kentuckians died of a drug overdose last year. He said the introduction of the synthetic opiate fentanyl into the heroin supply was largely driving the death rate. In addition, fentanyl has been present in 53 percent of the drug overdoses recorded in Kentucky so far this year.

He said the Kentucky General Assembly passed a number of measures in the last five or six years to address opioid abuse, but it takes time for the full impact of those laws to be seen.

“People do get better,” Ingram said. “People do recover, although for those people on the front lines, it doesn’t seem that way.”

In what he described as a “rare bright spot, there were 70 million fewer dosage units of opioids prescribed last year in Kentucky than in 2011. (That percentage doesn’t include buprenorphine, a semisynthetic opioid that is used to treat opioid addiction.) There are still about 300 million dosage units of opioids being prescribed in Kentucky.

“This whole problem is the overexposure of opioids to our country and state,” Ingram said. “We are reducing that overexposure.”

He said the passage of House Bill 333 earlier this year would further drive down the number of opioids prescribed. It prevents doctors from prescribing more than a three-day supply of opioid painkillers, with some exceptions allowed. It also increased penalties for trafficking in opioids and authorized the state Office of the Inspector General to investigate trends in drug usage and trafficking.

Department for Medicaid Services Medical Director Dr. Gil Liu testified on the impact of opioid abuse disorder on Kentucky’s Medicaid program.

At the beginning of 2014 Kentucky spent about $56 million in Medicaid money on behavioral health and substance abuse treatment, he said. By the end of 2016, Kentucky was spending about $117 million in Medicaid money on those treatments.

Rep. Danny Bentley, R-Russell, asked what percent of people with substance abuse disorder have a behavioral health disorder, outside of the drug issue.

“Well over half of the people,” Liu said.

Adkisson said the impact of the opioid crisis on Kentucky’s health was staggering.

“Less obvious, however, is the toll that is taken on the state’s economic growth and development,” he said. “In Kentucky the opioid crisis has contributed to a low workforce-participation rate.

“At a time when job openings and investment in Kentucky are reaching record highs, we must provide the healthy productive workforce needed to grow the economy.”

Rep. Mary Lou Marzian, D-Louisville, asked how the state could fund the mental health, treatment and prevention programs needed after the governor recently proposed cuts of 17 percent for most state agencies in the current fiscal year to make up for an expected budget shortfall.

Department for Behavioral Health, Developmental and Intellectual Disabilities Medical Director Dr. Allen J. Brenzel said grant money is helping to pay for programs to tackle the opioid crisis.

“The good news … is that resources are coming,” he said. “That is something I don’t often say. We have received funding from the legislature, the governor’s budget and we have received a significant number of grants.”

Kentucky was recently awarded a $10.5 million federal grant to help on programs for opioid overdose victims, pregnant and parenting women, individuals re-entering society upon release from criminal justice settings and adolescents and young adults at risk of addiction.

“Now, what is very critical, is that we use those dollars, and guide those dollars to the most effective evidence-based intervention,” Brenzel said.

Wuchner said the grant money couldn’t come fast enough.

“Opioid addiction is a ravenous beast because its increasing tolerance requires individuals to take higher doses to stave off withdrawal and addiction spiral can happen quickly,” she said. “It fractures families, lives, communities and futures. It fills our headlines daily. It fills our courtrooms, our jails, our hospital ERs, our NICUs (neonatal intensive care unit). It fills our court dockets, and it fills our morgues.”

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Fentanyl crackdown bill clears House committee

For Immediate Release

February 16, 2017

Fentanyl crackdown bill clears House committee

FRANKFORT—A bill that would make it a felony to illegally sell or distribute any amount of fentanyl, carfentanil and related drugs tied to an increase in drug overdoses in Kentucky has passed the House Judiciary Committee.

Trafficking in any amount of fentanyl, a pain killer now frequently imported for illegal street sales, and drugs derived from fentanyl as well as carfentanil—a large animal anesthetic said to be 10,000 times more potent than morphine—would carry up to 10 years in prison under House Bill 333, sponsored by Rep. Kim Moser, R-Taylor Mill. Trafficking over certain amounts of the drugs could carry even longer sentences.

The bill would also make fentanyl derivatives—which potentially number 800 or more, state officials say–part of the same class of drugs as heroin and LSD. Those drugs are classified as Schedule I by the federal DEA which describes the drugs as having no “currently accepted medical use.”

“Whatever (fentanyl derivative) is thrown at us in the future will be a Schedule I controlled substance under Kentucky law,” if HB 333 passes, Office of Drug Control Policy Executive Director Van Ingram told the committee.

Fentanyl, carfentanil and fentanyl derivatives are being mixed with heroin and sold on the street as heroin or other drugs. Some cities and counties have experienced dozens of overdoses in the span of a day or two because of the potency of the drugs which, Ingram said, can be disguised as pharmaceuticals like Xanax or Percocet.

“The business model for drug cartels is to mix fentanyl with heroin and make it look like (something else),” said Ingram. “It’s a much better —- for them. It’s a very deadly situation for our population.”

HB 333 would also create a felony offense called trafficking in a misrepresented controlled substance for those who pass off carfentanil, fentanyl or fentanyl derivatives as an actual pharmaceutical, like Xanax. 

Another provision in the bill would limit prescriptions for fentanyl to a three-day supply with few exceptions, said Moser. Rep. Angie Hatton, D-Pikeville, questioned how the legislation would prevent someone from getting another dose from another physician after receiving their three days’ worth. Moser said the KASPER system, which tracks prescriptions written in Kentucky for all scheduled drugs, is still in place to monitor what is prescribed.

“This language does not preclude the fact that physicians have to document with the PDMPs or prescription drug monitoring programs. KASPER is still a way to monitor… that’s still a requirement,” said Moser.

HB 333 now goes to the full House for consideration.

–END–

Lawmaker says top issue for constituents is marijuana; oncologist advocates for safe access

02/12/2017 12:39 PM

Far and away the largest number of phone calls from constituents of Rep. Jason Nemes, R-Louisville, are in support of marijuana legalization, and he says he’s heard plenty of other lawmakers also getting the calls.

Nemes recently published online what voters are calling him about, and in a phone interview with Pure Politics he said the calls on marijuana come in three forms: advocating for medical marijuana in pill form, medical marijuana that can be smoked and full-scale state legalization of the federally illegal drug.

“I’m getting contacted on all three of those areas, I don’t know where I am on it, but the Kentucky Medical Association tells me there’s no studies that show that it’s effective,” Nemes said in a phone interview on Wednesday.

Dr. Don Stacy, a board certified radiation oncologist who works in the Kentucky and Indiana areas, said there’s a reason there’s no studies proving effectiveness — studies have not been allowed to take place.

“It’s one of those things where we can’t provide randomized phase three studies in cannabis without making it legal — that is the gold standard for any sort of medicine,” Stacy said. “We have a variety of studies of that nature from other countries of course, but American physicians are very particular about American data. The database we have now is plenty enough to say we shouldn’t be arresting patients for trying to help themselves.”

Stacy said he became interested in marijuana after he noticed some of his patients were doing better with treatment than similar patients. In reviewing their records and through private discussions with the patients, he learned “a significant portion” of those doing better were the patients using marijuana.

“I was surprised by that,” he said. “I’ve always been a skeptic of alternative medicines, but then I began to research the data. I was impressed with the data.”

Dr. Stacy said he’s had some particular patients who showed minor or moderate improvements or side effects, but patients who had to stop treatment because the toxicity of the treatment was so severe. The patients who had to stop treatment tried marijuana, and then they were able to complete their treatments showing “dramatic differences,” Stacy said.

Because of the improvements in patients, Stacy is advocating for safe and legal access to the drug.

Twenty-eight states and the District of Columbia allow access to medical marijuana in different forms. Through those states allowing access, Stacy said several show improvements outside of overall medical care.

In states that have legalized medical marijuana the suicide rate has dropped by 10 percent among males 18 to 40, he said.

“It says when people have serious medical or behavioral issues — if you cannot find the treatment that helps you then some people decide to end their lives, and cannabis apparently prevents a certain portion of people from doing that.”

Stacy said that there is also a 10 percent decrease in physicians prescribing narcotics in medical marijuana states. The effect of that, Stacy said is a 25 percent decrease in overdose deaths linked to narcotics in states with medical cannabis laws. With the level of heroin and opiate abuse in Kentucky, he said there would be positive effects seen here too.

“I think that one-quarter of the people who will overdose and die of narcotics in this state in this year would be alive if we had a medical cannabis law.”

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How police tracked down a suspected heroin dealer after a rash of overdoses in Nicholasville

By Karla Ward

kward1@herald-leader.com

 

When a narcotics detective with the Nicholasville Police Department heard about a surge in heroin overdoses in Jessamine County this week, he got busy.

The detective, also a task force officer with the U.S. Drug Enforcement Administration, notified Nicholasville Emergency Medical Services Tuesday that if there were more suspected heroin overdoses, he wanted to be notified. Within two hours, he got a call about a crash involving a suspected overdose.

Court records show that the police work that followed resulted in a federal charge Thursday against a suspected drug dealer. Jeffrey James Ruggiero was charged in U.S. District Court in Lexington with possession of heroin with intent to distribute. His first court appearance was scheduled for 1 p.m. Friday.

According to an affidavit, the chain of events began when emergency workers arrived on Southbrook Drive in Nicholasville at 7:02 p.m. Tuesday and found a driver, Nathaniel Brezeale, “in obvious distress with agonal breathing and eyes closed.”

Suspecting an overdose, they administered 3 milligrams of Naloxone, and the man revived.

Brezeale’s girlfriend told investigators “that he had a substance abuse problem” and that before the accident, they had been to a double-wide mobile home in Garrard County, where Brezeale went inside alone and stayed for about 10 minutes.

While driving back to Nicholasville, Brezeale began to act strangely, so she asked him to pull over. When he did, the vehicle’s front wheels went over a curb. Passersby called emergency crews.

Two DEA task force officers went to St. Joseph Jessamine and interviewed Brezeale, who told them that he had called Ruggiero that night and asked about buying heroin. He had bought from Ruggiero before, he said.

When Brezeale got to the mobile home, he told investigators, he paid $25 for a tenth of a gram of heroin, which he said Ruggiero took from a larger plastic bag of heroin. Ruggiero placed the heroin onto a piece of paper, and Brezeale snorted it before he left.

A DEA special agent went to Lancaster, found the mobile home and began surveillance about 9:40 p.m., according to the affidavit.

About five minutes later, a Chevrolet Impala left the mobile home heading toward Nicholasville, and the special agent followed. He called Nicholasville police and asked for help. Officers clocked the Impala going 64 mph in a 55 mph zone.

The Impala was stopped, but the driver wouldn’t cooperate. However, “a Nicholasville K-9 was presented to the vehicle and a positive alert was noted. A subsequent search of the vehicle resulted in a quantity of suspected heroin being seized,” the affidavit states.

After that, a search warrant was obtained for the mobile home on Carlotta Drive.

Just before midnight Tuesday, about five hours after Brezeale’s accident, officers from the DEA in Lexington, the Nicholasville police detective bureau and Kentucky State Police went to the mobile home and detained Ruggiero while they searched the home and outbuildings.

Police seized about 1 gram of suspected heroin, plus prescription medication, several sets of digital scales and packaging material, and Ruggiero admitted that he had sold heroin to Nathaniel Brezeale earlier in the day, according to the affidavit.

Emergency crews responded to nine overdoses in Jessamine County in a 24-hour period Monday and Tuesday.

Karla Ward: 859-231-3314, @HLpublicsafety

Read more here: http://www.kentucky.com/news/local/crime/article126283869.html#emlnl=Morning_Newsletter#storylink=cpy

U.S. Attorney General addresses opioid, heroin addiction during Richmond town hall

BY CRITLEY KING CNHI News Service

Lynch

RICHMOND — U.S. Attorney General Loretta Lynch spoke to a crowded auditorium at a Town Hall meeting in Richmond as part of the Obama Administration’s newly designated National Prescription Opium and Heroin Epidemic Awareness Week.

The audience, mainly consisting of young people, was addressed on the dangers of heroin and opioid addiction, the pathways that lead to destruction, and the redeeming hope that help is available.

“I want to hear your questions, I want to hear your comments, I want to hear your ideas about how we can solve this (crisis), and about how we can prevent this,” said Lynch on Tuesday at Madison Central High School. “It’s not just putting people in jail, its about stopping it before it happens. And making sure people that do have a problem get treated.”

In her opening comments, Lynch asked the nearly 500 students if they had been considering where they would go to college, what careers they had planned for their futures, whether as journalists, doctors, law enforcement, teachers or fashion bloggers.

Then, Lynch told the students to look around at their classmates and friends and asked them to consider that last year, in Kentucky, approximately 12,000 died from opioid and heroin abuse overdoses.

“Imagine if all of you and others who fill these chairs were suddenly gone,” said Lynch. “And then that each of you had a friend, just one of your friends each, all gone. That’s what happened last year in Kentucky. That’s why this is so important.”

The chief law enforcement officer in the U.S. spoke about not only the problem of substance abuse and how to stop it, but also how to prevent it from even starting.

Lynch also put out a call to action to the students.

“We are talking to young people like you, because you have a role in this effort,” she said. “We want you to understand the issues, we went you to understand how serious it is, and we went to give you the information you need to make good choices in your own life. We also need you to look out for each other.”

During a question and answer session with local high school students, Kayla Greene, who lost her son to overdose, Tonya Snyder, MCHS social worker, Alex Elswick, a recovered addict, and MCHS student Julia Rahimzadeh, joined Lynch onstage.

Later in the day, Lynch traveled to make remarks at the University of Kentucky. Both events were part of the awareness week and the President’s Cabinet and Federal agencies’ focus on work being done/new efforts to address the national prescription opioid and heroin epidemic, according to a release by the Office of the Press Secretary.

The release also noted that Federal agencies are currently taking actions such as:

Expanding substance abuse treatment in the TRICARE system so that it includes intensive outpatient programs and treatment of opioid disorders with medication-assisted treatment.

Working with the Chinese government to combat the supply of fentanyl and its analogues from entering the U.S.

Increasing patient limits from 100 to 275 for practitioners prescribing buprenorphine to treat opioid use disorders.

Support programs that increase access to healthcare, substance abuse treatment, and educational opportunities in rural areas, such as telemedicine and distance learning.

Currently, the President is seeking $1.1 billion in new funding to combat opioid abuse.

During a press conference following the town hall meeting, Lynch told The Register, that one of the ways the Department of Justice funding specifically would assist communities on a local level would be through a grant making process that provides assistance to law enforcement through grants for additional officers, resources to help states improve their prescription drug monitoring programs and provide examples of programs that are working efficiently and consistently.

Lynch reiterated that administration wide, when treatment is spoken of, they are referring to improving and increasing the availability of treatment facilities and also treatment within local hospitals.

Critley King writes for The Richmond Register.

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Black market fentanyl use increasing in Kentucky

  • Deborah Highland
  • Aug 15, 2016

    ent3

    Fentanyl, an opioid painkiller 50 to 100 times more powerful than morphine, was found in the toxicology screens of 420 people who died in Kentucky last year of drug overdoses.

    That’s a 247 percent increase from 2014, when 121 people who died of drug overdoses had fentanyl in their toxicology screens, according to numbers provided by Van Ingram, executive director for the Kentucky Office of Drug Control Policy.

    “We’re seeing a huge uptick in fentanyl in Kentucky,” Ingram said.

    Pharmaceutical fentanyl is used in hospitals during surgery and is also provided in pain patches to people with severe, chronic pain, such as a cancer patient. But unlike opioid pain pills that have been diverted to the black market for years, pharmaceutical fentanyl isn’t what street dealers or drug abusers are using, Ingram said.

    “We’re not seeing pharmaceutical fentanyl being diverted but instead it is being produced out of the country and being smuggled in,” Ingram said.

    The drug is being made in clandestine labs primarily in Mexico and China, he said.

    “We’ve not seen a lot of labs in the United States, although there have been a few. The real danger of fentanyl is it is so powerful that skin exposure or powder exposure through the mouth and nose can put law enforcement at great risk,” Ingram said.

    Recently, the DEA sent out a warning to law enforcement agencies urging officers not to conduct field testing on suspected fentanyl and to instead package it and send it off to a crime lab for testing, he said.

    Most often when police encounter fentanyl, it’s found in heroin or being sold as heroin. But with the availability of pill presses, some dealers are using fentanyl to make pills that look like real pharmaceutical products such as oxycodone.

    “If an individual buys pills off the street, there is really no assurance that what it says on the pill is really what they are getting because of the black market use of pill presses and other drugs,” Bowling Green-Warren County Drug Task Force Director Tommy Loving said. “By buying pills on the street, it could actually turn out to be a fatal error in judgment.”

    The DEA has seized pills all over the country that look like one drug but in reality contain illegally produced fentanyl, Ingram said.

    “It’s really scary stuff with people making their own opioids and shipping them across the country,” he said.

    “What we’re seeing is a lot of fentanyl analogs as well. It’s not the same chemical compound you would find in pharmaceutical fentanyl. You don’t know what you’re getting, or how powerful it is,” Ingram said.

    Narcotics investigators in Warren County haven’t seen much of the drug, Loving said.

    “But we’re very much aware of it, and it’s dangerous,” he said.

    “It’s much more potent than heroin and there are different versions of it being manufactured. … A little bit of this powder, if you come into contact with it on your fingers or skin or happen to breathe a little bit of it, can be fatal. And we are looking into obtaining Narcan for all of our detectives in part due to this danger that they may now be exposed to,” Loving said.

    Narcan is a drug that counteracts the effects of an opioid overdose.

    South Central Kentucky Drug Task Force Director Jacky Hunt already has Narcan for his investigators, who unknowingly encountered the drug last year during an undercover drug buy. Officers thought the purchase was of heroin.

    When Hunt received the lab testing results of the substance his agency bought, the drug turned out to be fentanyl instead.

    “My guys handled fentanyl and didn’t even know it,” Hunt said.

    The drug is most often seen with heroin in Kentucky or sold as heroin, Ingram said.

    Ingram’s office has written some grant requests to try to obtain Narcan for law enforcement in an attempt to save as many lives as possible, he said.

    — Follow Assistant City Editor Deborah Highland on Twitter at twitter.com/BGDNCrimebeat or visit bgdailynews.com.

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    Cannabis

  • Maryland has recently been cited as a state with a high rate of opioid addiction, and now some are seeing legalizing marijuana as taking a lead against the epidemic and are also urging southern states like Kentucky to join in.

    https://i1.wp.com/cdn.inquisitr.com/wp-content/uploads/2016/05/Tennessee-Congressional-Candidate-Had-180-Marijuana-Plants-On-Property.jpg

    Maryland has recently been cited as a state with a high rate of opioid addiction, and now some are seeing legalizing marijuana as taking a lead against the epidemic and are also urging southern states like Kentucky to join in.

    Newsmax reports that nine states will be voting on marijuana legalization in 2016, but is there some specific reason Maryland is urging southern states to join in?

    The Hill explained in an opinion piece on August 4 that Maryland will be fighting back at the opioid epidemic in their state by legalizing marijuana. They also state that some drug treatment specialists in Maryland are considering medical cannabis as treatment for opioid addiction due to a recent study from the University of Georgia.

    Citizens in the state of Kentucky have also expressed an interest in this form of opioid treatment, but medical marijuana is still illegal in the state despite recent considerations, as previously reported by the Inquisitr.

    Part of the reason that Maryland could be urging other states to join in with legalizing cannabis pertains to the lack of opioid treatment options in other states in the south.

    For example, NPR reported on June 15 that those in the opioid treatment industry in Georgia were outraged when the state decided to place limits on opening new clinics.

    The rehabilitation clinics they do have are needed because Georgia has almost 70 opioid treatment programs. By contrast, nearby Tennessee has 12, Alabama has 24, and Mississippi has one.

    Although any clinic for opioid addiction is better than no clinic at all, many Kentuckians have learned from states like Massachusetts, that they need to have medical marijuana options, specifically for opioid addiction, according to CBS News.

    States that use marijuana to treat addiction could also become leaders because the numbers of opioid deaths are rapidly increasing nationwide.

    Whether it is heroin, painkillers, or fentanyl, Americans are now dying at higher rates from opioid drugs, and the rate exceeds other types of accidents. For example, Vox wrote on June 2 that more Americans were killed by painkillers (42,000) in 2014 than car crashes (34,000), or gun violence (34,000).

    Naturally, any help Kentucky can get to fight opioid addiction with or without legalizing marijuana would be welcome, and a 2015 report from the Boston Globe about the epidemic in Eastern Kentucky quoted a drug treatment prevention worker stating the following.

    “We’ve lost a whole generation of people who would have been paying taxes, and buying homes, and contributing to society.”

    Eastern Kentucky has been highly documented in regards to having one of the worst opioid epidemics in America, and an investigative report about the Appalachian crisis in the Guardian in 2014 stated that “stigma and inadequate access to treatment are the biggest barriers to overcoming the ongoing crisis in Appalachia and across the country.”

    However, outside of being an effective treatment for battling the state’s opioid epidemic, many Kentuckians are excited to see the other improvements that legalizing marijuana, or hemp, could have for economies like the one in Eastern Kentucky.

    According to some reports, the process begins with decriminalizing marijuana. The act of decriminalization of marijuana will also likely protect the prominent illegal operations already deeply entrenched in Eastern Kentucky, as described by Columbus Dispatch.

    Kentuckians for Medical Marijuana published a 2013 study by Charles B. Fields, Ph.D., Professor of Justice Studies at Eastern Kentucky University, that stated “economic benefits… can be realized by the State of Kentucky by both receiving tax benefits and reducing expenditures enforcing current marijuana laws.”

    In other words, there is a price to pay to keep marijuana illegal in Kentucky, and legalizing cannabis or decriminalizing the growing, selling, or distribution could reduce Kentucky’s overall drug enforcement costs.

    Currently, the unregulated marijuana industry in Eastern Kentucky produces an estimated $4 billion per year, according to a commonly cited 2008 History Channel documentary on Appalachia called Hillbilly: The Real Story.

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