(KY) This Week at the State Capitol

For Immediate Release

February 17, 2017

This Week at the State Capitol

February 13 – 17, 2017

FRANKFORT — Headlines in recent days have made it clear that Kentucky’s problems with heroin, other illegal opioids and prescription drug abuse, continue to take lives and devastate communities at a shocking rate.

In-state newspapers have recently reported the more than 52 drug overdoses occurred over a 32-hour period in Louisville, and nine overdose calls came in over 12 hours in Madison County. A national publication reported that one rural Kentucky county filled enough prescriptions over 12 months to supply 150 doses of painkillers to every person in the county.

The same conversations held across the state about the way the drug crisis is impacting the court system, police, health care workers, treatment facilities, social workers, prison officials and families are also being held in the State Capitol. Those deliberations resulted in a number of bills aimed at addressing the issue, including several bills that took steps forward in the legislative process this week.

On Tuesday, the Senate approved Senate Bill 14, which is aimed at getting drug dealers off the streets by strengthening penalties for trafficking in heroin and fentanyl, a powerful synthetic opioid. Under the legislation, which was approved on a 36-0 vote, trafficking in less than two grams of these substances would be elevated to a Class C felony punishable by five to 10 years in prison.

Later in the week, a pair of bills addressing the drug crises were also approved in the House committees.

House Bill 333 would make it a felony to illegally sell or distribute any amount of fentanyl, carfentanil – a powerful opioid intended for large animals – and related drugs. Trafficking any amount of these drugs could result in up to 10 years in prison under the legislation. The bill would also restrict prescriptions for some painkillers to a three-day supply, though exceptions would be allowed in some circumstances. House Bill 333 was approved by the House Judiciary Committee and now goes to the full House for consideration.

The House Education Committee approved House Bill 145, which would help fight opioid addiction by requiring that public school students be educated about the dangers of prescription pain killers and their connection to addiction to heroin and other drugs.

Bills on other issues that advanced in the General Assembly this week include the following:

· Senate Bill 1 is a sweeping education reform measure that sets the course to change educational standards and accountability for public schools. The more than 100-page-long bill is an omnibus measure aimed at empowering state education officials, locally-elected school board members and teachers to decide the best teaching methods for their communities. It would set up several committees and advisory panels to review educational standards. The bill would change how students are tested, and it would also set up a new way for intervening in low-performing schools by placing more power in the local school district during those interventions. The bill passed the Senate on a 35-0 vote and now goes to the House for consideration.

· House Bill 14 would give police, firefighters, and emergency medical services personnel protection under the state’s hate crime statutes. Under the bill, those who assault, kidnap, or commit certain other violent offenses against first responders could face stricter sentencing in court. Currently only the legally-protected classes of race, color, religion and national origin, as well as sexual orientation, are covered under the state’s hate crime statute. House Bill 14 passed the House on a 77-13-1 vote and has been sent to the Senate.

· Senate Bill 78 would require public schools across Kentucky would to go smoke-free by next school year. The bill would outlaw the use of all tobacco products, including electronic cigarettes, on elementary, middle and high school campuses in addition to buses. The bill was approved by the Senate on a 25-8-2 and has been sent to the House.

· Senate Bill 75 would increase the amount donors can contribute to election campaigns. Under the legislation, individuals and political action committees could donate $2,000 in the primary and general elections in Kentucky– up from the $1,000 limit. The bill passed the Senate on a 27-10 vote and has been delivered to the House.

· House Bill 192 would make it easier for 16- and 17-year-olds in foster care to apply for driver’s permits and driver’s licenses. The bill, which passed 96-0 before being sent to the Senate,  would allow those in foster care to get a driver’s license or permit without requiring them to have a parent’s or other adult’s signature on the permit or license applications.

Members of the General Assembly are eager to receive feedback on the issues under consideration. You can share your thoughts with lawmakers by calling the General Assembly’s toll-free message line at 800-372-7181.

You can also write any legislator by sending a letter with the lawmaker’s name to: Capitol Annex, 702 Capitol Avenue, Frankfort, Kentucky 40601.

–END–

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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

The Law of Unintended Consequences: Illicit for Licit Narcotic Substitution

Image result for heroin plant

Originally written July 15, 2014 at LINK below

Martin R. Huecker, MD and Hugh W. Shoff, MD, MS

 

The dealers will not use it. Heroin dealers have explicit knowledge of the addictive properties of their product. The heroin addict is no longer the desperate character living under a bridge. She is a 17-year-old high school senior who runs out of her grandmother’s oxycodone. He is the stockbroker who weighs the economics of purchasing one oxymorphone on the street for $100 or ten doses of heroin for $200. Because these people are ingesting and injecting products of unknown composition and unfamiliar potency, they can potentially overdose. If lucky, they end up in the emergency department rather than the morgue.

Kentucky ranks third in the nation in drug overdose mortality rate per 100,000 persons, with opioid pills making up the majority.1 In response to these statistics, the State of Kentucky passed House Bill One (HB1) in April 2012, effective October 2012. Also known as “the pill mill bill,” HB1 contains provisions intended to limit opioid prescriptions by pain management physicians and by other acute care providers such as emergency physicians. To prescribe narcotic pain medications, physicians must perform a full history and physical, prescribe only a short course, educate the patient on risks of controlled substances, and obtain a report from a statewide prescription monitoring program (PMP) (Kentucky All Schedule Prescription Electronic Reporting [KASPER]).2

As a result, the number of registered KASPER users in Kentucky has gone from 7500 to 23,000 from December, 2011 to November, 2012. Reports are up from 3300 to 17000 in the same time frame.3 According to the same press release, Kentucky witnessed a decrease of 10.4% total prescriptions in the first six months since HB1 was enacted.3

Mandating PMP reports, as sixteen states currently do, leads to an increase in reports, but so far no statistical difference in opioid overdose mortality.1,4,5,6 In fact, this legislation may not even lower the rate of opioid consumption, rather may shift which opioids are being prescribed.6

Researchers in Ohio looked at the impact of real time PMP information on opioid prescriptions. With PMP data, providers changed prescriptions in 41% of cases; 61% giving fewer opioids but 39% prescribing more opioids.7

House Bill One was intended to and has reduced opioid prescriptions in Kentucky. Forty-four pain clinics in Kentucky closed overnight.8 Preliminary analysis at a large, metropolitan emergency department has shown a decrease in prescriptions for hydrocodone and oxycodone, along with a decrease in ED administration of these medications. This type of “pill mill” legislation has been passed in Louisiana, Florida, Texas and California with varying results.9

Florida had a sharp decrease in opioid prescriptions after similar legislation. Having 90 of the top 100 physicians on the Drug Enforcement Agency (DEA) 2010 list of top opioid purchasers, Florida saw the number decrease to 13 in 2011, and zero as of April 2013.10 In 2011, Ohio passed a “pill mill bill” to crack down on pain management clinics.11 This legislation led to seizing of 91,000 prescription pills with 38 doctors and 13 pharmacists losing their medical licenses. In the end, 15 medical professionals were convicted on diversion charges.11 With all of this, pill overdose deaths began to decline, but heroin overdoses “skyrocketed.”11

The unintended but foreseeable consequence of such measures has been increase in distribution, abuse, and overdose of heroin. Heroin has gained market share in a similar way in the past. In 2010, Purdue Pharma began manufacturing a reformulated OxyContin after a $600 million fine for misrepresentation.12 Endo Pharmaceuticals Inc. followed in 2011 with an Opana ER reformulation. This resulted in making the pills harder to crush into powder for snorting or injecting.13,14 States such as Florida, Ohio, Minnesota, and Utah have seen patients turn to heroin after crackdown on prescription opioid availability.11,14

The New England Journal of Medicine warned us of what would be a two-fold increase in heroin use after the reformulation of Oxycontin.15 In the 2010 ODLL report, the United States DEA also attempted to warn health care organizations that Oxycontin users might switch to heroin.16,17 The first paper we know of to report this warning was published 3 years later in 2013.16 This paper, a qualitative study of the transition of opioid pill users to heroin users, provides insight into the economic and convenience factors associated with the switch. The researchers interviewed a small sample of heroin users, forty-one in all. All but one of the 19 heroin users aged 20–29 started with pills and progressed to heroin – “termed pill initiates.”16

Numerous popular news reports directly implicate decreased opioid pill availability in the rise of heroin abuse and overdose.16 However, very little discussion of this phenomenon has entered the emergency medicine literature.

The drug cartels have capitalized on the United States opioid appetite and now decreased supply of pills. The route from Mexico to Detroit, then south through Ohio, ends up in northern and central Kentucky. The Kentucky State Police recovered 433 samples of heroin in 2010. In 2012 the number was 1349.13 In Lexington, KY, the eight total heroin arrests in 2011 exploded into 160 in the first 6 months of 2013.18,19 Undercover narcotics officers in Lexington find it easier to buy heroin than marijuana.

Heroin-related overdoses in Kentucky increased from 22 cases in 2011 to 143 cases in 2012, and 170 in the first 9 months of 2013.8,20,21 Kentucky’s percentage of overdose deaths involving heroin went from 3.2 in 2011 to 19.5 in 2012 and up to 26 in 2013.8.21 This phenomenon has occurred in Florida, California, Massachusetts, New York, Oregon, Washington and Ohio.11,2224

The emergency medicine literature has minimal recent discussion of heroin overdose management in the ED; nor have we discussed secondary prevention. Supportive therapy suffices in the ED, with liberal naloxone use and airway protection. State and federal actions to curb heroin deaths can be effective. Good Samaritan laws, present in only one third of states, protect from prosecution those lay individuals attempting to help themselves or companions in overdose situations.

Also present in only one third of states are laws to expand community access to reversal agents such as naloxone. Twenty-two states have laws requiring or recommending education for opioid prescribers. Medicaid expansion to cover substance abuse treatment has occurred thus far in less than half (24) of states.1

As more states enact measures intended to reduce total opioid prescriptions, legislators and healthcare providers alike must be aware of the predictable and devastating rise in heroin sales, abuse, and overdose. Funding for this legislation should include monies allocated toward substance abuse treatment programs and availability of naloxone. Similarly, pill mill bills could universally be coupled with Good Samaritan laws in anticipation of the increase in parenteral opioid overdoses. Funds could be allocated to lay population education via public service announcements. Stricter punishments for drug traffickers could accompany such legislative changes. Many of these measures have been presented as interventions to combat prescription opioid abuse and can now be applied to the subsequent heroin abuse and overdose dilemma.9

At the first line of medical care, emergency physicians must be involved in efforts to minimize collateral damage in this long-term process of curing America’s addiction to opioid drugs and their horrible consequences.

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Kentucky Senate passes bill that could make heroin traffickers face homicide charges

 

 

SB 5 passed 36-0 Thursday with Sen. Perry Clark, D-Louisville, passing.

By Kevin Wheatley, Published: January 17, 2014 10:19AM

The Senate passed a bill Thursday to combat the state’s growing heroin problem, though not without questions during a committee hearing earlier in the day on certain provisions’ constitutionality.

Senate Bill 5 passed 36-0 with Sen. Perry Clark, D-Louisville, passing.

SB 5 would require those convicted of trafficking more than 4 grams of heroin or methamphetamine to serve at least 50 percent of their prison sentence before becoming eligible for probation, parole or early release. Traffickers could be charged with homicide in cases of overdose deaths, and the bill would require coroners to report overdoses caused by Schedule I drugs, such as heroin.

“The bill targets two different groups: the trafficker, who needs to be run out of Kentucky or locked up; and the addict, who has broken the law but has created their own personal prison of addiction that is worse than any jail this state could design and needs treatment,” the bill’s sponsor, Senate President Pro Tem Katie Stine, said.

The legislation would allow the Department of Medicaid Services to expand treatment options and direct a quarter of savings realized through a corrections reform bill passed in 2011 to supplement the Kentucky Agency for Substance Abuse Policy.

SB 5 would also allow police officers and emergency responders to carry and administer naloxone, a drug used to counter opiate overdoses; grant immunity from drug possession charges for those seeking help for someone overdosing; and grant immunity from paraphernalia charges for those who alert law enforcement of any hypodermic needles or sharp objects in their possession before a search. Some could be given leniency for helping prosecute other drug crimes.

Kentucky Office of Drug Control Police Executive Director Van Ingram said the state has had problems with opioid addiction for years, and the heroin trend has evolved from opiate-based painkillers such as OxyContin and Opana. The numbers of heroin overdoses and confiscations have risen dramatically in recent years, he said.

“Senate Bill 5, I think, takes a broad view and it hits on a number of things, all aimed at reducing the availability of heroin, educating our citizens about heroin and some harm reduction things to try to keep people alive,” Ingram said during testimony before the Senate Judiciary Committee. 

“We can’t get people into treatment and we can’t get them leading productive lives if they’re gone.”

Supporters of the bill cross party lines with Stine, R-Southgate, Rep. John Tilley, D-Hopkinsville, and Democratic Attorney General Jack Conway backing the measure.

The heroin issue extends beyond northern Kentucky, which supporters of SB 5 spotlight as an area of the state wracked by heroin addiction because of its close proximity to Cincinnati. Clay Mason, public safety commissioner for Lexington-Fayette Urban County Government, said central Kentucky has seen a rise in heroin abuse in recent years.

“This is not a back alley drug situation from the movies of the late ’60s and early ’70s. This is anybody’s problem,” Mason told the committee. “There are many, many people who, as we’ve already heard, have gone from a pill prescription addiction problem and now rolling into heroin for a multitude of reasons — price and availability.”

Ernie Lewis, a lobbyist for the Kentucky Association of Criminal Defense Lawyers, raised concerns about the constitutionality of certain parts of SB 5, specifically in prosecuting dealers of Schedule I substances whose drugs cause overdose deaths.

Offenders convicted of homicide or fetal homicide where the victim dies from such an overdose would not be eligible for release until serving at least half his or her sentence, under SB 5.

Lewis specifically pointed to a provision eliminating the defense that victims contributed to their deaths by willingly ingesting substances, sometimes more than the Schedule I drugs at the center of SB 5.

“Many overdose deaths occur when a person combines drugs; they combine that cocktail, unfortunately,” he said. “They may take cocaine, they may take Xanax, they may take other benzos (benzodiazepine, a psychoactive drug) or opioids. Sometimes the defendant is not even aware of that because that might have occurred earlier, because when you’re sick, you take whatever’s available to you.

“… Foreseeability has to do with the awareness of a risk. The prosecution has to prove awareness of a risk, and this provision says as a matter of law, the risk is there, we’re going to presume it, and they can’t do that under the due process of laws.”

SB 5 is meant to clarify an issue raised in a 2000 Kentucky Supreme Court decision overturning a reckless homicide conviction in which the victim died of an overdose from a mixture of cocaine and heroin, Stine and Tilley said.

“It seems to me that all that provision is doing is eliminating the ‘blame the victim’ defense, and I think we can all agree that’s not a bad thing.”

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