Kentucky has the nation's highest rate of lung cancer incidence and death. Nearly 9 out of 10 lung cancer deaths are caused by smoking cigarettes or secondhand smoke exposure, says the U.S. Centers for Disease Control and Prevention. (Getty Images)

Increasing state cigarette taxes has proven to be an effective policy to decrease smoking rates, and it appears that is also true in Kentucky.

Nearly 30 percent of Kentucky adults smoked in 2011, two years after the legislature had doubled the cigarette tax to 60 cents a pack. Following a 50-cent increase to $1.10 in 2018, the state’s adult smoking rate fell to 17.4% in 2022, the last year for which a rate is available.

Shannon Baker, the American Lung Association’s advocacy director for Kentucky and Tennessee, said that while she could not point to something definitive to explain why Kentucky’s smoking rate has been decreasing, as has also been the case in the nation, she could speak to the impact of raising cigarette taxes:

“When taxes increase, smoking rates decline. We should take advantage of that, for goodness sake, and increase the cigarette tax in Kentucky by at least $1 and then tax all other nicotine products at parity with the cigarette tax.”

After the initial boost in cigarette-tax revenue from the rate hikes in 2011 and 2018, revenue from the tax declined 24% from 2019 to 2024.

The legislature increased the tax to 30 cents from 3 cents in 2005, but smoking rates before 2011 should not be compared with those after that because of a change in survey methodology, says the Behavioral Risk Factor Surveillance System, a continuing federal-state poll of Americans’ habits.

Baker stressed that its important to take advantage of all policies that are known to decrease smoking. Beyond raising taxes, she said it’s important to fund the state tobacco-control program and enforce the law against underage sales, which she said would result in fewer youth becoming addicted to nicotine and growing up to be lifelong smokers, and all the health issues that come with that.

The new report on state General Fund receipts for the fiscal year that ended June 30 showed a 1.5% increase in receipts from other tobacco products, such as electronic cigarettes or vapes.

Asked about the impact of vaping on decreasing smoking rates, Baker focused her comments on young people, who are more likely to vape than smoke.

“We really have to get a handle on this youth vaping problem,” she said, noting that Kentucky is one of about 10 states that doesn’t require tobacco retailers to be licensed. “We don’t even know where all of these shops are in order to enforce the law against underage sales.”

Baker added, “We really need a better method of enforcing the law against underage sales. And what that looks like is licensure and routine regular enforcement opportunities that result in significant penalties all the way up to license suspension and revocation, for scofflaws that routinely violate the law. We’re not talking about any onerous policy on those who are compliant with the law. We’re simply talking about those who violate the law and violate it routinely.”

The 2023 Youth Risk Behavior Survey found that 5.3% of Kentucky high school students said they currently smoked cigarettes and 19.7% said they used electronic vapor products. Among middle schoolers, 2.2% said they smoked cigarettes and 12.8% used a vapor product. “Current use” is considered having used a product on at least one day during the 30 days prior to the survey.

Asked if she thought the new law that bans retailers from selling unauthorized vapor products would be effective in decreasing youth vaping, as it has been touted to do, Baker said, “House Bill 11 turned into . . . an industry market-share grab and nothing more; it is not a protection for kids. What we saw was a bill passing that, in effect would, if it’s upheld in court, remove certain products, primarily imported products, from the market shelves, which in and of itself is not a bad thing. But, it certainly doesn’t protect kids who will just switch to the other products that remain on the shelves.”

The law has been challenged in court. If it holds up, it will go into effect in January 2025.

Baker also wanted to make sure people know that the funds for the state’s tobacco control program come from the Master Settlement Agreement with cigarette manufacturers, not from the cigarette tax.

“We need to increase funding for tobacco control because … Kentucky has the highest lung-cancer incidence and mortality rates in the entire nation and most of that is due to our high smoking rate,” Baler said. “So even though the smoking rate may be declining, it isn’t gone. It isn’t good, even.”

This story is republished by Kentucky Health News

(Getty Images)

Kentucky is one of five additional states that will soon provide Medicaid health coverage for people nearing release from prison or juvenile detention, according to the U.S. Department of Health and Human Services.?

“We’ve been eagerly anticipating CMS’s approval of Kentucky’s healthy re-entry demonstration for years now,” said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

The program started as a demonstration focused on treatment for substance-use disorder during incarceration and “has expanded to focus on putting in place all of the physical and behavioral health treatment, care coordination, and wrap-around supports justice-involved Kentuckians need to successfully return to their communities and thrive,” Beauregard said in an email.?

This demonstration program is operated under a partial waiver of the Medicaid program’s inmate-exclusion policy. Without the waiver, Medicaid won’t pay inmates’ care unless they are admitted to a hospital.

“Providing avenues for greater health outcomes is always the right thing to do, and this program does just that,” state Cabinet for Health and Family Services spokesperson Brice Mitchell said in an email.

Before the state can start the coverage, it must submit an implementation plan to the Centers for Medicare and Medicaid Services, Mitchell said: “Upon receiving implementation approval from CMS, Kentucky will cover a select set of pre-release health-care services through Medicaid and the Kentucky Children’s Health Insurance Program for up to 60 days before an individual’s expected date of release.”

Kentucky didn’t take full advantage of the waiver, which allows states to provide coverage up to 90 days before the expected release date. Eligibility is based on income; the limit is 138 percent of the federal poverty level.

Mitchell added, “The individual must be eligible for Medicaid or KCHIP to qualify and must be a state inmate housed in one of Kentucky’s 14 prisons or a post-adjudicated juvenile in the custody of the Department for Juvenile Justice.”

Mitchell provided data from the state Department of Corrections, which said “There are 19,220 individuals serving felony convictions in state prisons or jails, as well as an additional 49,700 on active supervision with the Division of Probation and Parole. At least 95% of the state inmate population will be released from incarceration at some point.”?

Kentucky’s waiver doesn’t allow inmates in jails to participate, because Kentucky jails are operated by counties, not the state. Beauregard said, “We’ve advocated for allowing jails to opt in, if they are willing to meet requirements and participate fully.” She said the state Department for Medicaid Services “has said they will consider [jails] as a future phase of this project.”

Coverage will be available not only to adult prisoners, but incarcerated youth, under the Children’s Health Insurance Program, called KCHIP in Kentucky. Beauregard praised the inclusion of youth in the coverage, which was not part of the original demonstration program for substance-use-disorder treatment and not part of the original application for its expansion.?

“Another important expansion from the original waiver is that youth who are in detention facilities will also get these services and wrap-around supports, which has the potential to reduce recidivism,” Beauregard said.?

A July 2 news release from HHS noted that incarcerated people often report higher levels of substance-use disorders, chronic health conditions and other health concerns, and that people transitioning out of jail or prison can experience delays in obtaining access to Medicaid or CHIP.?

HHS Secretary Xavier Becerra said in the release, “For people involved in the justice system, ensuring a successful transition back into the community includes having the health-care supports and services they need.”

Kentucky is the first Southern state in the program. The other newly approved states are Illinois, Oregon, Utah and Vermont. California, Massachusetts, Montana and Washington had already been approved.

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Syringe exchanges provide intravenous drug users with clean needles to prevent the spread of bloodborne diseases like HIV and hepatitis. (Getty Images)

Attorney General Russell Coleman issued details Thursday of more than $12 million in grants from the state’s opioid settlements for prevention, enforcement, treatment and recovery.

One of the grants will expand a syringe exchange, and was not supported by Coleman’s appointees to the commission. He confirmed at an event Thursday that he opposes the exchanges.

“I’m extremely concerned that needle exchange further perpetuates drug use, and it will not be supported by me or this administration,” he said in response to questions at an event he held to highlight the grants.

Coleman said the 51 grant recipients, chosen from 160 applicants, represent “bold ideas” aimed at trying to “save lives and tackle this crisis,” with a focus on the three-legged stool of prevention, treatment and enforcement.

“We’re building programs and services that help Kentuckians for the next generation,” he said.

The announcement was made at DV8 Kitchens in Lexington, which employs people in recovery and is getting a $151,730 prevention grant to establish an employee-success mentorship program.?

“By connecting those in recovery with meaningful employment, we can give them a second chance at success,” DV8 owner Rob Perez said in a news release from Coleman’s office.?

At the event, Perez stressed that while DV8 is “for people,” its success is also good for the community. “Every time one person doesn’t return back to addiction, we saved $37,000 as a community,” he said.?

Coleman’s office oversees the Kentucky Opioid Abatement Advisory Commission, which the legislature created in 2021 to distribute the state’s portion of the $900 million in settlements with opioid manufacturers and distributors. The money is being paid in installments. The commission has awarded $55 million in 110 grants, including $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in 11 pilot counties.?

Coleman said it’s important to remember where this settlement money comes from. “This is blood money, purchased by pain and devastation of families across this commonwealth, which is why we must be such stewards of this money,” Coleman said. “We’re honoring those we’ve lost by our stewardship and how we use this money effectively.”?

Half of the settlement money goes to the state and the other half goes to cities and counties. The commission is housed in the attorney general’s office and is headed by Chris Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Syringe exchanges

Evans was one of the Coleman appointees who did not support a grant to the Boyle County Agency for Substance Abuse Prevention at the June 4 commission meeting. In passing on the vote, he revealed Coleman’s position on syringe exchanges.

The grant was approved by a majority vote. Coleman took office in January and has not yet made all of his five appointments; those members serve two-year terms. The other voting members are appointed by the University of Kentucky or serve by virtue of their office, including Coleman, who has designated Evans to hold his seat.

Two of the five positions that are appointed by Coleman were reappointed in June 2023, before he took office, with their terms expiring June 30, 2025. They included Karen Butcher and Von Purdy, both representing citizens at-large. Coleman appointed Darren “Foot” Allen, representing law enforcement, in February and that term will expire June 30, 2025. The other two positions to be appointed by Coleman expire at the end of this month. At this time Van Ingram, representing the drug treatment and prevention community, and Jason Roop, representing victims of the opioid crisis, fill those positions.

Asked if Coleman will make decisions about future appointments to the commission dependent on the person’s view of syringe exchange programs, spokesperson Kevin Grout answered “No” in bold letters in an email.

Kentucky Health News asked Coleman if his lack of support for syringe exchanges for intravenous drug users, which are supported by research, could put a chilling effect on future applications for these programs.

He replied, “There’s been no grant that has been blocked because of my personal opposition.” He went on to say, “I don’t support needle exchange. I support very robustly prevention, treatment and enforcement.”

Asked if he had research to support his opinion, he said, “I’m a strong proponent of Narcan [an anti-overdose drug] and I’m a strong proponent of prevention. I’m very concerned that particularly when there’s not a one-to-one ratio, a one-to-one return on needles that it is an enabler versus the harm reduction that we’re actually seeking.”

Some syringe exchanges have a one-for-one requirement, but regional health official Scott Lockard said in 2016 that most exchanges at that time used a “patient negotiation model,” giving the user as many needles as they need for one week to assure they use a clean needle each time, often up to a capped number.

“The goal is that they use a clean needle for each time they inject,” Lockard said then. He said it is impossible to adhere to a strict one-for-one requirement. For example, he said users don’t always keep up with their syringes or sometimes will tell you they are sharing them.

Coleman said he is a very strong advocate for wide distribution of Narcan, “given the nature of the threat we’re seeing. … Narcan needs to be as ubiquitous as a fire extinguisher given this threat. But it always has to be Narcan plus a pathway to treatment, Narcan plus education. Because Narcan itself can be an enabler in some contexts. We want to make sure it’s always coupled with treatment, coupled with prevention.”?

Coleman also talked about his plans to build a statewide drug prevention program, with a goal of rolling it out this next school year.?

“We exist in a commonwealth where as little as one pill can and is taking our sons and our daughters,” he said. “But yet we lack a statewide prevention effort in our commonwealth. That will change.”

Coleman’s office declined to release details of the grants until Thursday’s event.

Here’s a summary of how the 23 new prevention grants will be used:?

Anderson County Agency for Substance Abuse Prevention, $171,100 for expansion of school-based prevention efforts and law-enforcement training.

Appalachian Research & Defense Fund (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.

Big Brothers Big Sisters of the Bluegrass, $185,301 for a high-school mentoring program, to empower high school students to become positive role models for younger students.

Boys and girls Clubs of Kentuckiana, $200,000 for an innovative program aimed at opioid prevention for youth aged 6-18.

Carter County Public Library, $101,500 to hire resource specialists to prtovide greater access to recovery-oriented programming.

Covington Partners, $225,450 for prevention programming that includes out-of-school-time programs, school-based health services, mentoring, drug and violence prevention and family engagement.

Cumberland Trace Legal Services (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.

DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730 for the mentorship program, which will focus on removing barriers, supporting career-path development and job readiness while supporting recovery and wellness.

Girl Scouts of Kentucky Wilderness Road Council, $59,052 to launch the Building the Bridge to K-12 Girls Leadership Project, a community-based prevention program that focuses on increasing girls’ positive childhood experiences.

Jewish Family and Career Services, Louisville, $77,207 for enhancement of wraparound services for youth, to include opioid addiction screening and active prevention.

Legal Aid Society, $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.

Legal Aid of the Bluegrass, $125,000, same as above.

Mercy Health – Lourdes Hospital, $76,552 for a hospital-based, pharmacy-led tapering program, which slowly resudes doses of a drug over time to reduce withdrawal symptoms.

Operation Parent, $87,011 for prevention education of parents of 4th, 6th and 9th grade students in several Kentucky counties.

The Safety Blitz Foundation, $126,335 for a pilot version of The Coaches vs. Overdoses program, which addresses youth opioid misuse, the proliferation of synthetic opioids including illicit fentanyl, through prevention, education, awareness and community drug-disposal programming.

Scott County Sheriff’s Office, $91,847 for Drug Abuse Resistance Education in 5th and 9th grades.

Taylor County Schools, $208,824 for a school-based prevention program.

Three Rivers District Health Department, Owenton, $320,803 for a partnership with the Planet Youth program to implement a population-wide primary prevention process designed to take informed actions to increase protective factors, decrease risk factors and ultimately change the environment of children and youth.

University of Kentucky Research Foundation, $380,572 for development of prevention coalitions in Fayette County, educating 4th through 12th grade students and building community capacity and engagement around prevention efforts.

Operation UNITE, $751,850, for continuation and expansion of its Educate. Empower. Prevent. Program, which provides prevention training to students from 4th through 12th grades.

Wanda Joyce Robinson Foundation, Frankfort, $90,472 to start a youth substance intervention and prevention program that prevents substance use and abuse and promotes positive youth development and stronger families. The foundation helps children with incarcerated parents.

WestCare Kentucky, $100,404 for Camp Morilla, a free addiction prevention and mentoring day camp program for youth ages 9-12 and their families who have been impacted by family opioid use.

Young Men’s Christian Association of Greater Louisville, $248,487 for the YNOW Mentoring Program, which focuses on helping youth develop healthy drug-and violence-free lives.

Here is a summary of how the 28 new treatment and recovery grants will be used:?

Appalachia Regional Healthcare, $94,572 for expanding its peer recovery team so peer recovery coaches can be placed in four more hospitals.

Backroads of Appalachia, $167,025 for women in recovery with workforce training and employment opportunities.

Boyle County ASAP, $282,610 for expansion of its harm reduction program (including a syringe exchange), resilient-kids programming and case management efforts.

Celebrate Recovery Fairdale, $30,004 for weekly recovery meetings.

Center for Employment Opportunities, $255,109 for expansion of employment services for justice-impacted individuals in treatment or recovery.

Chrysalis House, Lexington, $227,273 for treatment for pregnant and parenting women.

Comprehend, Inc., $426,087 for opening a buprenorphine clinic in a community mental health center.

Eastern Kentucky Concentrated Employment Program, $450,000 for career and support services for people who are in recovery and comorbid polysubstance use who are interested in entering or re-entering the workforce.

Family Nurturing Center of Kentucky, $221,937 for services to children impacted by their caregiver’s opioid use and provides needed support to parents in recovery.

Family Scholar House, $245,110 for a five-step approach revolving around wrap-around services during and post-treatment to progress individuals from ‘crisis to stability’ targeting single parents, foster alumni, individuals facing reentry and post-secondary students.

Grin Grant, Lexington, $361,251 for expansion of dental restoration scholarships and peer support services and launch of a new recovery program.

Hope Center, $680,280 for in-patient, residential treatment for men.

Hope Springs Church, $50,462,Supports regular recovery support meetings and events.

Horsesensings, Inc., Bagdad, $115,219 for therapeutic job training in the horse industry and housing for those in recovery.

Isaiah House, $250,000 for recovery housing and job training aftercare opportunities for those in long-term recovery.

Kentucky Hospital Research and Education Foundation (Ky. Hospital Assn.), $250,000,Supports expansion of a program that ensures patients have 24/7 access to care.

Lake Cumberland Area Development District, $277,552 for case management and supportive services to individuals in recovery seeking to re-enter the workforce.

Life Learning Center, Covington, $498,500 for “a cutting-edge, technology-enhanced system designed to fill existing gaps in recovery services by providing continuous, real-time data, support and accountability.”

Mercy Health-Marcum and Wallace Hospital, Irvine, $179,834 for recovery services for individuals with criminal justice involvement.

Natalie’s Sisters, $88,356 for expansion of services for women who have been sexually exploited or trafficked.

Northeast Kentucky Regional Health Information Organization, $331,997 for the Career Ready Workforce Project, which will focus prevention efforts on high-school students preparing to enter the workforce, individuals struggling with addiction ,and local agency staff members seeking to increase employable skills.

Ramey-Estep Homes, Rush, $222,801 for teen prevention-education programming, expansion of first-responder trauma-treatment programming and expansion of treatment and recovery access.

Recovery Café Lexington, $276,278 for expansion of recovery support model to a third location in Frankfort.

Transitions, Inc., Covington, $156,000 for expansion and enhancement of treatment services, as well as expansion of community education and prevention activities in the African American community.

Voices of Hope-Lexington, $538,021 to increase the quantity and quality of recovery support services for people in or seeking recovery.

Volunteers of America Mid-States, $664,587, for two recovery community centers in Lincoln and Pulaski counties.

Four Rivers Behavioral Health, Paducah, $232,251 for a mobile recovery support vehicle program that provides services to adults.

Young People in Recovery, Louisville, $301,440 for peer-led chapter and life-skills curriculum programs for people seeking recovery and a youth prevention program for middle- and high-school-aged children and their parents in five communities.

This story has been updated with information from Kevin Grout, spokesman for Attorney General Coleman.

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Used syringes are ready for safe disposal at a needle exchange clinic where users can pick up new syringes and other clean items for those dependent on illegal injectable drugs, Feb. 6, 2014 in St. Johnsbury, Vermont. (Photo by Spencer Platt/Getty Images)

The leader of the agency that makes grants from the state’s opioid settlements declined to support funding for a syringe-exchange program, saying Attorney General Russell Coleman does not support such programs — which are considered a key tool for reducing harm to people who inject drugs.

Kentucky Opioid Abatement Advisory Commission Director Chris Evans, who works for Coleman, passed on a June 4 vote that approved a grant to the Boyle County Agency for Substance Abuse Prevention, one of 119 such county agencies.

“This application does increase outreach, which includes educational training, Narcan distribution and referrals to treatment,” Evans said. “However, the request does increase the funding of the syringe-service position, which the Office of the Attorney General does not support syringe exchange programs. So I will be passing on the vote of this application.”

Asked later why Coleman opposes syringe-exchange programs, Coleman spokesman Kevin Grout said in an email, “Attorney General Coleman is committed to supporting effective prevention, treatment and enforcement efforts. He strongly supports the distribution of Naloxone and other overdose reversal drugs. However, he cannot support syringe-exchange programs, which he believes enable drug use without effectively promoting recovery.”

Elected in November, Coleman, a Republican, is a former FBI agent and former U.S. attorney under President Donald Trump.

Syringe exchanges are supported by research. The U.S. Centers for Disease Control and Prevention says injection drug users who have access to syringe exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

The exchanges were authorized by the state’s 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. As of March 14, the state had 80 operational syringe exchange programs in 65 counties.

Later voting against the grant request because of their opposition to syringe exchange programs were commission members state Treasurer Mark Metcalf and retired Master State Trooper Darren “Foot” Allen, whom Coleman appointed to fill a slot representing law enforcement. Allen said, “There’s some people that I trust that tell me this is okay. However, I’m just not in favor of needle exchange. I suspect that this time next year, I won’t change my position but I am open to looking at that option,” he said.

Despite the opposition, Boyle County’s ASAP grant request for $282,610 passed with a 6-2 majority vote. The commission is comprised of nine voting and two non-voting members from the legislature.

Third round of grants approved

The Boyle County grant was the only one put up for a vote that had any opposition at the commission’s June 4 meeting. In all, the commission members approved 51 organizations to receive just over $12 million in grant money.

The legislature created the commission to distribute the state’s portion of the approximately $900 million in settlements with opioid manufacturers and distributors, half of which goes to the state and the other half goes to cities and counties. The commission is housed in the attorney general’s office and is headed by Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Of the $12 million in this round of grant money, 28 of the awards were given for treatment and recovery, and 23 were given for prevention. This is the third round of state grants, with $32 million awarded to 59 groups in the first round and $13.9 million awarded to 34 groups in the second round.

Asked for brief details of each grant, Grout said they would be announced next Thursday at a press conference at DV8 Kitchen-East End in Lexington, one of the grant recipients.

The 28 new treatment and recovery grants are:

Appalachian Regional Healthcare, $94,572.

Backroads of Appalachia, $167,025.

Boyle County ASAP Board, $282,610.

Celebrate Recovery Fairdale, $30,004.

Center for Employment Opportunities, $255,109.

Chrysalis House, $227,273.

Comprehend Inc., $426,087.

Eastern Kentucky Concentrated Employment Program, $450,000.

Family Nurturing Center of Kentucky, $221,937.

Family Scholar House, $245,110.

Grin Grant, Lexington, $361,251.

Hope Center, Lexington, $680,280.

Hope Springs Church, $50,462.

Horsesensing Inc., $115,219.

Isaiah House, $250,000.

Ky. Hospital Research and Ed. Foundation (Ky. Hospital Assn.), $250,000.

Lake Cumberland Area Development District, $277,552.

Life Learning Center, $498,500.

Mercy Health – Marcum and Wallace Hospital, Irvine, $179,834.

Natalie’s Sisters, $88,356.

Northeast Kentucky Regional Health Information Organization, $331,997.

Ramey-Estep Homes, $222,801.

Recovery Café Lexington, $276,278.

Transitions Inc., $156,000.

Voices of Hope – Lexington, Inc., $538,021.

Volunteers of America Mid-States, $664,587.

Four Rivers Behavioral Health, $232,251.

Young People in Recovery, $301,440.

The 23 new prevention grants are:

Anderson County ASAP, $171,100.

Appalachian Research & Defense Fund (Legal Aid), $125,000.

Big Brothers Big Sisters of the Bluegrass, Inc., $185,301.

Boys and Girls Clubs of Kentuckiana, $200,000.

Carter County Public Library, $101,500.

Covington Partners, $225,450.

Cumberland Trace Legal Services (Legal Aid), $125,000.

DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730.

Girl Scouts of Kentucky Wilderness Road Council, $59,052.

Jewish Family and Career Services, $77,207.

Legal Aid Society, $125,000.

Legal Aid of the Bluegrass, $125,000.

Mercy Health – Lourdes Hospital, $76,552.

Operation Parent, $87,011.

The Safety Blitz Foundation, $126,335.

Scott County Sheriff’s Office, $91,847.

Taylor County Schools, $208,824.

Three Rivers District Health Department, Owenton, $320,803.

University of Kentucky Research Foundation, $380,572.

Operation UNITE, $751,850.

Wanda Joyce Robinson Foundation, $90,472.

WestCare Kentucky, $100,404.

Young Men’s Christian Association of Greater Louisville, $248,487.

The grant application portal is closed until the commission opens it for the next round of awards.

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

The nursing home industry says the cost and a shortage of nurses make it impossible to comply with a new federal rule on staffing levels in nursing homes. (Getty Images)

The nursing-home industry is pushing back against a new Biden administration rule that sets minimum staffing requirements for federally funded long-term care facilities and will require many of them to hire more nurses and nurse aides.

Morgan Jemtrud, director of communications for the Kentucky Association of Health Care Facilities and the Kentucky Center for Assisted Living, told Kentucky Health News in an email that the staffing mandate is not attainable for several reasons, including the health-care workforce shortage.

Biden administration unveils new rule on nursing home staffing levels

“The staffing mandate is impossible. CMS estimates it will cost around $300,000 per building (AHCA estimates more), but there is no funding to support the implementation of the rule,” said Jemtrud. “Also, the required staff are simply not available. RNs are in demand across all health-care sectors, and no pipeline is being built to produce the number of RNs this rule requires.”

Jemtrud was referring to an analysis from the American Health Care Association, a nursing-home lobby, that says meeting the mandate would require nursing homes to hire more than 100,000 more nurses and nurse aides at an annual cost of $6.8 billion. The analysis also says 94% of nursing homes were not meeting at least one of the proposed staffing requirements.

?New staffing requirements

The Nursing Home Minimum Staffing Rule requires all nursing homes that receive Medicare or Medicaid payments to provide 3.48 hours of direct nursing care per resident per day, including a defined number for registered nurses (0.55 per resident per day) and nurse aides (2.45 hours per resident per day).

?“This means a facility with 100 residents would need at least two or three RNs and at least 10 or 11 nurse aides as well as two additional nurse staff (which could be registered nurses, licensed professional nurses, or nurse aides) per shift to meet the minimum staffing standards,” says a White House fact sheet about the rule.

?It will also require facilities to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care.

The new staffing requirements will be phased in over three years, except at rural facilities, which will get up to five years. The law allows for some “limited, temporary exemptions” for facilities in areas with workforce shortages that demonstrate a good faith effort to hire the required staff.

?Within two years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, according to a Kaiser Family Foundation analysis. But the analysis says only 19% meet the defined number of hours required for RNs (.55)? and nurse aides (2.45) that is required under the full implementation of the law.

For-profit nursing homes are cutting corners on safety and draining resources

“When facilities are understaffed, residents may go without basic necessities like baths, trips to the bathroom, and meals – and it is less safe when residents have a medical emergency,” said the fact sheet,? noting that it will also “ensure that workers aren’t stretched too thin by having inadequate staff on site.”

Brice Mitchell, spokesperson for the state Cabinet for Health and Family Services, told Kentucky Health News in an email that the administration is reviewing the federal rule and its impact.

?“Medicaid funds 70% of all long-term care in the state and there is ongoing work to expand a nurse career ladder to help increase recruitment,” Mitchell said. “At this time, we are unable to determine the number of Kentucky nursing homes that don’t meet the new federal rules.”

Good first step, says nursing home ombudsman?

Denise Wells, executive director of the Nursing Home Ombudsman Agency of the Bluegrass, said her group was “very pleased” with the 24-hour RN requirement, but didn’t think the minimum hours per resident per day went far enough.

She said? the 24/7 RN requirement is important because the acuity level of patients has increased over the years, meaning patients need more assistance with their activities of daily living than ever before. And, she said, “Medical emergencies don’t just happen for eight hours of the day; they can happen 24 hours a day.”?

Wells said they were disappointed in the hours per resident per day only being 3.48 because research shows that the minimum care that an average resident needs is 4.1 hours per day.

“And that is simply to avoid negative health outcomes,” she said. “It’s not to live their best lives, it’s not to have the greatest quality of life, it’s just to have that minimum care provided.”?

Wells called the new staffing rules a “good first step.”

“We are trying to make sure that the message is that this is not the ceiling; that it’s a floor,” said Wells. “It’s the absolute minimum, but facilities should be staffing higher than this. . . . Nursing homes are required to staff to sufficient levels to meet resident needs, and so if they have residents that their care plan indicates that they need more than the 3.48 hours per day, then the facility needs to staff to meet that need.”

Can nursing homes afford more staff?

Jemtrud with KAHCF and KCAL was asked about the financial impact of the rule. She said Kentucky nursing homes are already financially strained and there are no funds to help meet the new requirements.

“Before this rule, 79.9% of Kentucky facilities are in distress or at risk of financial distress using the Altman Z-score,” Jentrud said, citing a formula used to determine a company’s risk of bankruptcy.?

“CMS estimates the total cost of the final rule at about $4.3 billion per year, but AHCA continues to estimate the cost above $6 billion per year,” she said. “There are no funds from Medicare, Medicaid, or other payers to increase payment rates to providers for any of the rule requirements.”

Wells, asked how facilities can address the health-care workforce shortage, said her group prefers to call it a “job quality crisis” caused by low pay, poor conditions and little support.? She pointed to reports from the National Consumer Voice for Quality Long-Term Care that have showed how nursing homes hide profits, and saif there is not enough transparency in how Medicaid and Medicare dollars are used these facilities.

KFF Health News also points to researchers who are “skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors.”

In a lengthy statement from the American Hospital Association, Stacey Hughes, AHA executive vice president, said, in part, “CMS’ one-size-fits-all minimum staffing rule for nursing homes creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements.”

The American Health Care Association issued a statement in opposition of the mandate and said the industry will keep pressing Congress to overturn the regulation.

“While it may be well intentioned, the federal staffing mandate is an unreasonable standard that only threatens to shut down more nursing homes, displace hundreds of thousands of residents, and restrict seniors’ access to care,” Mark Parkinson, CEO of the AHCA, said in a statement. “Issuing a final rule that demands hundreds of thousands of additional caregivers when there’s a nationwide shortfall of nurses just creates an impossible task for providers. This unfunded mandate doesn’t magically solve the nursing crisis.”

The mandate also implements stronger transparency measures to ensure nursing home residents and their families know when a nursing home is using an exemption, according to the fact sheet.

Guthrie expresses concern?

Jemtrud said industry associations will “continue to reach out to Congress where there’s been bipartisan support for helpful legislation.”

“Providers have been hosting legislators for visits within their facilities to share firsthand the challenges they’re facing,” she wrote. “Also, the AHCA/NCAL Congressional Briefing scheduled June 3-4 will allow members to discuss their concerns directly with members of Congress on Capitol Hill.”?

On Tuesday, U.S. House Republicans at a House Energy and Commerce health subcommittee voiced their concerns about the new staffing mandate.

The subcmmittee chair, Republican Rep. Brett Guthrie of Kentucky’s 2nd District, said he was “extremely concerned” about the mandate along with the 80/20 rule which requires agencies that provide home- and community-based services to spend 80% of their Medicaid payments on compensation for workers who directly provide care.

Guthrie said both rules “threaten access to long term care services for Medicaid beneficiaries by setting arbitrary staffing and pay standards. . . . This approach simply won’t work.” He added later, “These rules come at a time where we have seen more than 500 nursing home facilities close since the start of the pandemic and where we have 150,000 fewer long-term care workers than we did before 2020.”

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Jan. 16 is the deadline to sign up for health insurance on the Kynect marketplace. (Getty Images)

Kentuckians can still shop for and enroll in federally subsidized health insurance coverage on the state-based marketplace, Kynect, though Jan. 16 for coverage starting Feb. 1. That will be the end of open enrollment for 2024.

To sign up, Kentuckians can visit?kynect.ky.gov?or call 855-459-6328. They can also get help at a local Department for Community-Based Services office from a Kynector or a licensed health insurance?agent?at no cost.

“They’ll guide you through the process of finding quality, affordable health care coverage that’s best suited for you and your family,” Gov. Andy Beshear said Thursday at his weekly press conference.

Kentuckians who don’t have coverage through an employer, Medicare, Medicaid, the Kentucky Children’s Health Insurance Program, or the Pentagon’s Tricare program can shop for individual coverage on Kynect.

The Kynect website also provides a?prescreening tool?to see if your family may be eligible for benefits.

A?Kentucky Voices for Health?blog post about the open-enrollment process said four of five Kentuckians are eligible for tax credits that can make premiums less than $10 a month, and many are eligible for $0 monthly premiums.

As of Jan. 4, Beshear said 71,414 Kentuckians have signed up for health insurance through Kynect, 8,852 more than last year. “This, I believe, is our strongest year, at least since the relaunch” of the state-based exchange, he said.

“Three years ago, I made it a priority to relaunch Kynect, because I believe health care is a basic human right,” said Beshear. “Today, I’m pleased to see so many Kentuckians taking advantage and receiving the benefits they deserve.”

The Senate budget is good news for Medicaid funding, although it funds fewer waiver slots than the House budget for Kentuckians with disabilities. (Getty Images)

The Kentucky Hospital Association’s annual?Workforce Survey Report?says Kentucky suffers from an “acute shortage” of health care workers, with nearly 13,000 job vacancies in hospitals across the state at the end of 2022.

“While the shortage of health-care workers is nationwide, it has hit the commonwealth especially hard, and KHA is working with multiple partners to find ways to address the challenges,” KHA President and Chief Executive Officer Nancy Galvagni said in a?news release.

The KHA Workforce Survey Report provides an in-depth look at the non-physician hospital workforce in Kentucky. It found that Kentucky had a 15% vacancy rate among that workforce in 2022.

Of the 13,000 open jobs, nearly 5,000 were openings for registered nurses and nearly 300 for licensed practical nurses, teh survey found. And, there are over 1,000 open slots for nursing aides.

For the first time, hospital-employed paramedics, EMTs and other EMS personnel are included in the report. They had the highest vacancy rate among non-nursing occupations (19.2%), followed by respiratory therapists (15%) and behavioral-health professionals (12%).

The survey report shows vacancy rates differ from region to region with only two area-development districts, Green River and Fivco in the northeast, having vacancy rates below 10% for registered nurses and all hospital employees. The Kentucky River ADD, in the southeast, has the highest vacancy rate, with nearly 24% of its hospital workforce and 34% of its RN positions vacant.

The survey shows that the shortage of registered nurses is the most pronounced, with four AD districts having registered-nurse vacancies above 20 percent – Barren River (21.2%), Lincoln Trail (22.3%), Buffalo Trace (22.4%), and Bluegrass (23.7%). Vacancies employee vacancies above 20 percent, Kentucky River (23.7 percent).

The report notes that the level of vacancies means wait times are longer for those seeking treatment.? KHA says it is working with hospitals to actively convene partners to address these provider shortages, including the?Kentucky Chamber of Commerce, the Council on Postsecondary Education?and the Kentucky Community and Technical College System, along with nurses and hospital administrators.

“Our primary objectives are to expand Kentucky’s health care workforce pipeline, remove barriers to health care education, retain the current health care workforce, and redesign models of care,” Russell F. Cox, president and chief executive officer of Norton Healthcare and chair of the KHA Workforce Committee, said in the release. “Through extensive public and private sector collaboration, we are poised to help more Kentuckians attain rewarding, long-term careers in health care while improving the health of our communities.”

The news release notes that the work of this committee is crucial because a new Global Data study, commissioned by KHA and the Kentucky Board of Nursing, shows there will be a shortfall of 6,000 RNs by 2035, which is about the same as it is today.

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

In a session focused on challenges of getting the psychedelic drug ibogaine approved by the Food and Drug Administration for treating addiction with help of the state’s opioid settlement funds, a cardiologist said it couldn’t be done in a reasonable time and the drug is unsafe.

“My opinion is that ibogaine is not safe, the efficacy is unproven, it’s unlikely to be approved by the FDA in a reasonable time period, and the cost to Kentucky would be unsupportable,” said Dr. Mark Haigney, a board-certified cardiologist and electrophysiologist, and an attending physician at the Walter Reed National Military Medical Center.

Haigney was invited to a special Kentucky Opioid Abatement Advisory Commission meeting on Oct. 17 by commission member Patricia Freeman, a pharmacy professor at the University of Kentucky. The meeting also saw the head of the commission discuss a “rough” plan for funding ibogaine research.

After two hearings that focused on ibogaine development and personal testimonies favoring the drug, she asked to invite experts in regulatory drug development to testify about the challenges of navigating ibogaine through the FDA process, given its potential for damage to the heart and its current classification as a Schedule I drug with no medical use.

Freeman said she had concerns that people at one hearing thought there would be quick access to ibogaine with the $42 million investment and felt compelled to ensure they understand that this would be a multi-year endeavor with no guarantee of success.

“I felt this was important as it would help make sure that at large, our commission would be as fully informed as possible prior to making a decision on proposed ibogaine funding,” Freeman said.

The proposal comes from Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor. Cameron appointed Hubbard to ?lead the distribution of $842 million in opioid settlements from drug companies. Ibogaine is illegal everywhere but Mexico and New Zealand, but has been anecdotally reported to stop drug-withdrawal symptoms.

Haigney, who described himself as an “expert in drug-induced sudden death and drug-induced loss of consciousness,” said that while he recognized the attractiveness of a single-dose drug like ibogaine to treat opioid-use disorder, such a drug must be “safe in the immediate term, effective in the long term, FDA-approved, and affordable for the huge number of Kentuckians with opioid-use disorder.”

He said ibogaine isn’t safe because it is known to cause cardiac arrhythmias and sudden death. In detail, he explained that this happens because ibogaine causes a “prolonged QT interval,” which is one of the measurements taken by a standard electrocardiogram.

A prolonged QT interval occurs when the heart muscle takes longer to contract and relax than usual, which can affect heart rhythms and lead to sudden cardiac arrest.

Haigney said the FDA requires all drugs to undergo cardiac testing and that “the finding of QT interval prolongation is the most common reason for removal of a drug from further development.”

He added that a prolonged QT interval can happen when a drug blocks the cardiac potassium channels to the heart and that ibogaine is a “potent blocker” of this channel, even with normal therapeutic doses.

“So this means that most if not all subjects would experience some significant degree of blocking the channel,” he said. “And this is a very poor prognostic finding for a drug.”

Haigney pointed to a study of 14 hospitalized patients who received a “relatively low dose” of ibogaine. The average increase in QT interval was 95 milliseconds. He said the FDA’s published guidelines say it is concerned when a drug prolongs the QT interval by 5 milliseconds or more.

“I’ve never seen a drug prolong the QT interval so profoundly,” he said, adding later, “This degree of QT prolongation would be expected, associated with increased risk of fatal events.”

He then asked rhetorically, “Can this drug be given safely?” His answer, “Yes, in the hospital. We do a lot of dangerous things in the hospital with a lot of technology,” adding that this would be “an incredibly resource-demanding” drug to administer.

“The likelihood that this drug with this safety profile will be approved by the FDA in less than 10 years, in my opinion, is remote and the effort will require at least a billion dollars,” Haigney said. “The administration of ibogaine would strain hospital resources at a time when bed shortages are severe. This is a treatment for wealthy individuals who can pay for hospitalization with intensive monitoring,” so it would not help most Kentuckians “who struggle with opioid dependence.”

Dueling experts

Freeman also invited Robert Walsh, recently retired from working in the National Institute on Drug Abuse for 36 years, where he headed NIDA’s Regulatory Affairs Branch.

Walsh spoke to the regulatory challenges of ibogaine development, including cardiac safety, ensuring enough supply of a plant-based drug from another country, creating a plant-based drug with the same dose in each pill, and the challenges of working with a Schedule I drug in laboratories and clinical settings.

Dr. Sidney Peykar, a cardiac electrophysiologist and medical director at the Cardiac Arrhythmia Institute, said the drug could be given safely in a hospital setting and said he has expanded the protocol for how to administer ibogaine safely at the Beyond Ibogaine Treatment Center in Cancun, Mexico.

“Most if not all of these deaths could be mitigated or completely prevented through safety protocols,” he said.

Dr. Javier Muniz, the FDA’s supervisory general-health scientist for controlled-substances initiatives, was asked if FDA would definitely not approve ibogaine. He said that without all of the information in front of him, “I have no idea.”

Asked by Freeman if a 95-millisecond QT prolongation would disqualify ibogaine from being approved, he said it’s important to remember that when the FDA is considering the approval of a drug, the agency looks at a drug holistically and considers both risks and benefits.

Hubbard was asked after the meeting if any speaker had caused him to change his mind about his ibogaine plan. He said, “Dr. Haigney was brought in here to oppose this initiative and he articulated all of the talking points that the opponents of this initiative have already parlayed at public remarks. So there was nothing that was either surprising, nor persuasive about his remarks, and insofar as what he has articulated, are already widely publicly disseminated talking points of opposition.”

He said Haigney was “thoroughly debunked [by] individuals who serve, respectively, on an FDA advisory board for psychopharmacology, as well as the science journal for the FDA’s research arm related to controlled substances.”

What’s next

At the end of the meeting, Hubbard gave the commission a “very rough draft” of a plan with a list of requirements that would have to be met before the commission would commit $42 million to the project. He did not release the plan, but told Kentucky Health News after the meeting that it contains these points:

• “Viable research proposals from qualified research entities” that will match the state’s $42 million
• The state would have ownership of any patentable intellectual property that is generated
• Clinical trials would be held in the West End of Louisville and in Wast Kentucky, “in a way that ensures social, racial, and economic equity of access to the treatment,”
• An approved drug-investigation application from the FDA “with secured clinical-trial sites and a diverse group of qualified clinical-trial participants before the first dollar is ever matched by the commission,”

“This will have to be a viable, go project before any commission resources are put on the table,” Hubbard said,. Nothing like this has ever been done. So all of this is breaking ground.” He cited “the competing interests, the areas of concern, the nature of this money, the necessity of protecting it, the necessity of making sure that the Commonwealth of Kentucky has a leadership position that is protected and recognized, and consideration of risk that we are taking by making this bet.”

When it comes time for the commission to vote, he said, “Theoretically, the vote will be to legally authorize a $42 million match from the commission for our clinical research team that is ready to conduct clinical trials with ibogaine in Kentucky.”

Hubbard said it is imperative that no vote be taken until Dr. Nolan Williams’ peer-reviewed research of veterans who have suffered from traumatic brain injury and received ibogaine is published and they hear from him about his findings. Williams is an associate professor at Stanford University.

At the commission’s first public hearing, Williams said he had let other professionals look at the data from his study and they said “the findings are shocking and that they’ve never seen a drug do this before.”

Before the eight guests spoke, Hubbard took about five minutes to address how he and the commission came to explore ibogaine and its potential therapeutic uses. He said as far back as 2018, he became aware of emerging science on therapeutic psychedelics and an author who at the time wrote about the topic and led him to other sources of information. Her newsletter The Journey is published on Substack. She wrote under the pen name of Julia Blum now uses the name Julia Christina.

Hubbard was responding to an Oct. 9 Daily Beast story, excerpted in Kentucky Health News, which reported that about the time Cameron implicitly endorsed his plan at a public event, a major national political contributor increased its investment in ibogaine research and later gave Cameron’s campaign a political boost. He is running against Democratic Gov. Andy Beshear, who has objected to Hubbard’s ibogaine plan.

Hubbard said, “It’s important to set the record straight in full public view, lest the fictitious narrative of a smoke-and-mirror smear job generated by a third-rate, agenda-driven political tabloid prevail in the public arena against the integrity and sincerity of all who have offered their time, expertise and visceral lived experiences for all the world to see on behalf of all Kentuckians.”

The commission’s next regular business meeting is scheduled for 1 p.m. Nov. 14 at 1024 Capital Center Dr., Suite 200, Frankfort.

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

Twenty-three people spoke in favor of funding the development of an opioid-use disorder treatment using the psychedelic drug ibogaine with some of the state’s opoid-settlement money at the Kentucky Opioid Abatement Advisory Commission‘s second and final public hearing on Friday, Sept. 15.

Foundation for a Healthy Kentucky President and CEO Ben Chandler, a former Kentucky attorney general and five-term congressman, opened the meeting by saying that he had seen this problem from almost every angle

Chandler spoke of a first cousin’s addiction to opioids and other drugs and at least 15 failed attempts at recovery, having gone to “about every rehab center that you could go into of any note in this country.” At age 30, the cousin “put a bullet to his head” and died. “He was like a brother to me.”

Then his real remaining brother, Matthew Chandler, died of a fentanyl overdose in January. Ben Chandler said his brother sought illegal opioids to manage his pain because he wasn’t able to legally obtain the pain medications he thought he needed, and he had been addicted to opioids for “probably 15 years.”?

Chandler also talked about the surge of Oxycontin in Eastern Kentucky in the late 1990s, when he was attorney general, and his efforts to combat it, then about his time in Congress and the “enormous sums of money” spent to address this problem.??

“The bottom line to me is, despite the best efforts of so many people working on this problem for so many years — and I mean that, they work their tails off, and they care deeply — we have been unable, in my judgment, to solve this problem,” he said. “It continues to be intractable, and we need as many tools as we can get.

“And I believe that a drug like ibogaine, from what I have read, it has the potential to make the difference that we need to have made, or at least a big difference. It’s a tool that we can give the people who are working in the trenches, which will give them the opportunity, maybe, to break this cycle of addiction and actually save quite a number of lives. And I endorse anything that we can do to get that done.”

Chandler said the proposed $42 million to fund this proposal, about 5 percent of the settlements with opioid makers and distributors, “is a drop in the bucket, compared to what has been spent over the years to try to deal with this problem. And spent quite frankly, to a large extent, unsuccessfully. We have successes, but we have a whole lot of failures. And I’ve seen those failures in my family, both my cousin and my brother, in and out of facilities, strong efforts to try to break the chain of addiction, both of them no longer with us.”?

Illegal, supported by anecdotal evidence

Ibogaine is illegal in the U.S. but has been anecdotally reported to stop the withdrawal symptoms of opioid dependence. The $42 million expenditure, to help get ibogaine federal approval in the next six years, was proposed by Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor.?

Joseph Barsuglia, a clinical psychologist and ibogaine researcher who also provided a long list of professional connections to ibogaine, talked about the first time he witnessed an opioid detoxification with ibogaine in 2015.?

“I could not believe my eyes,” he said. “To witness a patient with the most severe and chronic addiction you can imagine on death’s doorstep undergo a 48-hour process and come out calm, connected, with a new radiance in their eyes and really wanting to live — this is a miracle in the truest sense. With ibogaine, this is not a rare occurrence, this is the norm.”

Barsuglia said ibogaine works for opioid-use disorder because it “rapidly alleviates opioid withdrawal and cravings and promotes lasting sobriety in a manner that is superior to opioid-maintenance therapies,” and because “It induces dreamlike visions that increase insight into the causes of one’s addiction, which can lead to durable psychological change.”?

He said studies show that “ibogaine simultaneously targets addiction and craving to multiple substances, including alcohol, methamphetamines, cocaine and nicotine — not just opioid use disorder,” which is important because over half of opioid-use disorder patients are addicted to multiple substances.

Also, he said ibogaine is “fast acting and has durable outcomes.” He said it takes 12 months to break opioid dependence with methadone and 12 hours with ibogaine. He added, “It reduces anxiety, improves mood, does not require ongoing burden on the medical system and has little potential for abuse.”

The major objection to legalizing ibogaine are its risks to the heart. Barsuglia said that can be mitigated under a carefully controlled environment.

“I believe funding ibogaine research for opioid use disorder is perhaps one of the most obvious and necessary decisions that can be made in the history of addiction medicine,” he said.?

Personal testimonies

Several speakers gave personal testimonies about their experience with ibogaine, with a recurring message that it not only healed them physically, but also spiritually.

Paria Zandi, a licensed marriage and family therapist in California, said she describes her life as two distinct chapters, “pre-ibogaine and post-ibogaine,” and has been free of her opioid addiction for 10 years.?

“Through an intense 24-hour treatment, I emerged feeling reborn,” she said. “Not only did I escape the clutches of the physical withdrawal symptoms and cravings, but I also began to relive some of the traumas in my life and gained a newfound perspective. I saw myself as someone of immeasurable worth, and a child of God. I experienced a profound sense of aliveness and connectedness that had eluded me until that moment.”?

Zandi added that ibogaine is not a “cure-all” and if it is ever approved will need to be combined with social services, support systems and education. “We urgently need innovative approaches to addiction treatment, such as ibogaine,” she said.?

Navy SEAL veteran and ibogaine patient Tommy Aceto told the commisison, “It wasn’t just a medicinal treatment. It was a deep dive into my subconscious, self-forgiveness and most importantly, self-love.”

Reed Madison, a parent of an ibogaine patient, said of his son, “The reason he went to an ibogaine clinic is because ibogaine offered him a solution for addiction interruption without withdrawals. . . . So I feel incredibly lucky that I learned about ibogaine at the time to help give my son a way out of his addiction problem before it was too late. I think there’s a pretty good chance he may not be alive today had ibogaine not been available to him.”?

In closing, retired Marine Corps Lt. Gen. Martin Steele, CEO of Reason for Hope and the president of the Veterans Mental Health Leadership Coalition, called on the commission to vote unanimously to fund the ibogaine initiative.?

“Our nation owes its citizens a viable alternative to something that’s not working. You have it here in Kentucky, you have this moment in history, this moment in time,” he said. “To conclude, I implore each and every member of the commission to support this initiative. A unanimous vote will send a message that will resonate loudly, nationwide.”

Asked what was next, Hubbard told Kentucky Health News, “I think every commission member needs to take a little while to think over everything that they have heard. It’s a tremendous amount of information to absorb that’s been presented between May 31 and now we sit here on Sept. 15. And I think after some due diligence individually and collectively at some point, within some months, we’ll be ready to put a vote on the agenda.”

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentucky last year spent $130 million in Medicaid funds on addiction treatment, with most of the money coming from the federal government.?Fatal overdoses in the state have declined for two years. (Getty Images)

Kentucky has added two new syringe-service programs for intravenous drug users this year, bringing the total to 84 SSPs, in 65 of the state’s 120 counties. Hart County opened its program in January and Estill County reopened its program in April.

SSPs are part of what health departments call “harm reduction”? — programs that offer a host of strategies to minimize the negative physical and social impacts of drug use. They are also called syringe-exchange programs, or needle exchanges, for the best-known element of the prorgams.

Estill County’s program reopened after being shut down in 2020 because the Irvine City Council took away its approval, required by state law in a city where a program is based. The Estill County Health Department’s program is now in a mobile clinic that goes to multiple locations in the east-central Kentucky county.

Hart County is in south-central Kentucky, which is served by the Barren River District Health Department. Charity Crowe, a UK Healthcare health-education coordinator embedded in the department’s harm-reduction program, told Kentucky Health News that adding more SSPs to decrease overdose deaths is one goal of the Barren River Initiative to Get Healthy Together (BRIGHT) Coalition.

Only three of the eight counties in the district have SSPs. Warren County opened its program in 2016, Barren County in 2018, and Hart County in January.

Crowe said one of the first steps they took as they worked to get local approvals in Hart County was a survey of local jail inmates, asking f they would use an SSP if it was available. She said 63 inmates, or 64% of the survey respondents, said they would use it.

“That kind of helped us with getting everything passed through the Board of Health, Fiscal Court and City Council,” Crowe said. She praised the efforts of County Judge-Executive Joe Choate: “He was a huge supporter of the program and us getting it started, so that helped get everything moving along a lot quicker.”

Asked if she had any advice for people in the 55 Kentucky counties that still don’t have an SSP, but want one, she said it’s important to keep educating people about what they are and why they are important.

“Just to try to educate people on why we do what we do,” Crowe said. “There’s so much stigma surrounding the things that we do with harm reduction. … We are trying to make our communities a safer place, not just for people that use drugs, but for our kids, our first responders, everybody.”

She also encouraged them to not give up. “Pretty much anywhere that you go, you will get a little bit of pushback,” she said. “But in order for us to break that stigma, we just have to keep educating people.”

Looking to other counties in the district, Crowe said they have held an educational meeting in Edmonson County and are working to have one in Logan County. She said Logan County’s health board and Russellville City Council have approved an exchange, but the Fiscal Court has not.

Syringe-service programs not only exchange clean needles for dirty ones, to decrease the spread of blood-borne diseases like hepatitis C and HIV, but provide education on the safe use and distribution of wound-care kits and Naloxone, which blocks a drug overdose. Other services are infectious-disease screening, vaccinations, and linking people to housing, food access, insurance, medical care, substance-use treatment and behavioral-health services.

Crowe said the SSPs in Hart and Warren counties also use a peer-support specialist who has “been a phenomenal resource for our clients.”

On June 29, a new law kicked in that decriminalized fentanyl test strips in Kentucky, meaning they will no longer be considered drug paraphernalia. Because of this, Kentucky’s SSPs can offer them to their clients . Fentanyl was involved in 72.5% of the state’s 2,135 overdose deaths in 2022.

Fentanyl test strips are paper strips that can detect the presence of the powerful opioid in pills and other drugs within minutes. They are considered a low-cost method of helping prevent drug overdoses and reducing harm, according to the Centers for Drug Control and Prevention.

This article?is republished from Kentucky Health News, an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Families of soldiers who died by suicide hold signs in support of their loved ones during the Veterans Day Parade on Nov. 11, 2021 in New York City. (Photo by Spencer Platt/Getty Images)

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

Ibogaine is a powerful psychedelic that comes from a plant mainly found in Africa. It is illegal in the U.S. but has been reported to stop withdrawal symptoms of opioid dependence but also cause heart problems.

Pharmacist lawmaker wants discussion

Hubbard, the commission’s chairman, cut off discussion after Rep. Danny Bentley, who joined the meeting virtually, asked when the panel would be able to discuss the idea. State Health and Family Services Secretary Eric Friedlander also voiced concern that there was no discussion by the panel before Hubbard announced the plan May 31.

Bentley, a pharmacist and a Republican from Russell in Greenup County, said, “I think we should discuss it today.” Hubbard replied, “The motion on the floor is to adopt the public hearing schedule and that is what the discussion will be centered around.”

Friedlander and another commission member appointed by Democratic Gov. Andy Beshear learned about the ibogaine idea only when Hubbard revealed it at an event hosted by his boss, AG Cameron, the Republican nominee against Beshear in the fall election, Beshear said last month.

Hubbard said May 31 that the commission would “explore the possibility” of committing “no less than $42 million” to developing the treatment of ibogaine for opioid-use disorder, with a goal of getting it approved within six years from the U.S. Food and Drug Administration.

Hubbard took a few minutes to address what he said were misunderstandings. He said no funds have been allocated. “At this stage in the game, the only thing that we aim to do is to explore the possibilities related to ibogaine, its applicability as a therapeutic to opioid-use disorder,” he said. “And then the second question is whether and to what extent this commission would commit funds to help develop Ibogaine as a therapeutic to go through the FDA approval process. We’re a good bit away from answering that question.”

Sharon Walsh of the University of Kentucky, who oversees a multi-year, interventional research project to find tools for preventing and treating opioid addiction, with federal funding of $87 million, voiced several concerns.

Conflict of interest concern

Walsh asked how the settlement money could be used to explore a drug that has not been approved by the FDA because the commission’s guiding law clearly says that the money must be used on evidence-based pursuits.

There’s a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market. That’s why I’m asking for balance.

– Sharon Walsh, director of the University of Kentucky Center on Drug and Alcohol Research

Hubbard said the law includes language that would support this effort “insofar as it recognizes that the commission may allocate resources for any projects it deems appropriate.” Further, he said, “We are well within our legal ability to explore. . . and that’s the only thing we’re seeking to do here.”

Walsh also pointed out that there are mixed opinions about the use of ibogaine for opioid-use disorder. She asked if there would be “point-counterpoint” participants at the public hearing, or if it would only be people who are trying to develop it.

Hubbard said at least two subject-matter experts will be invited to the first public hearing, including Deborah Mash, founder and CEO of DemeRx, a pharmaceutical company developing ibogaine for treating addiction. He told Walsh that if she had an expert she would like to invite, they would work to include them.

Friedlander asked if the focus could be broadened to include other psychedelics, but Hubbard said that wasn’t possible, because while other psychedelic drugs are closer to FDA approval, they don’t appear to be as effective against opioid withdrawal syndrome, as ibogaine may be.

Walsh pushed back: “If the focus is on opioid withdrawal, we have medications that are already approved for opioid withdrawal. It’s not something that is difficult to manage clinically. And there are protocols that have been in place for 30-some years. . . .?Those are very effective drugs. I’m not sure why we need other drugs to target opiate withdrawal.”

Hubbard replied, “Well, there are others who would seem to believe that this is worth exploring”? and that it has “breakthrough therapy potential. I want to know if that’s true, right? And that’s why we’re having this exploration.”

Walsh also noted that she has known the proposed witness, Mash, for 30-some years and that Mash has been working on ibogaine since the 1990s.

“She’s the CEO of a company that’s trying to develop it. So she’s going to come and talk to us about the development of this with it, you know, with the hope of getting money. There’s a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market,” Walsh said. “That’s why I’m asking for balance.”

Hubbard replied, “Insofar as there are individuals who you know, with expert credentials that offer alternative views, please share those with the commission staff and myself.”

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

The head of the commission that manages Kentucky’s opioid-settlement money said Wednesday that the panel will “explore the possibility” of committing “no less than $42 million” to developing a treatment of opioid-use disorder with the psychedelic drug ibogaine, which is not legal in the United States.

Gov. Andy Beshear questioned the idea and said it was announced without consulting his two appointees on the Opioid Abatement Advisory Commission, which has yet to approve it. The commission operates under Attorney General Daniel Cameron, the Republican nominee against Beshear in the fall election.?

Bryan Hubbard, executive director and chairman of the commission, told reporters at the announcement event: “It is our hope that we can achieve an approval within six years” from the U.S. Food and Drug Administration for ibogaine.

“This is the first time an effort like this has ever been undertaken by an individual state in history,” Hubbard said. “So we are in uncharted territory by even discussing the possibility of executing this project.”?

Ibogaine is a powerful psychedelic that comes from a plant mainly found in Africa. It is anecdotally reported to stop the withdrawal symptoms of opioid dependence.

“Anecdotal evidence that is a mountain high and decades wide, suggests that ibogaine, within 48 to 72 hours of administration in safe, clinically controlled conditions, resolves opioid withdrawal syndrome,” Hubbard said.

“It appears to do so by clearing and resetting the brain’s opioid receptors, while also restoring the brain’s organic dopamine and serotonin production to pre-opioid exposure levels. If this anecdotal evidence can be clinically validated, ibogaine would represent a transformative therapeutic for the treatment of opioid-use disorder.”?

The commission’s news release about the idea did not mention any drugs, nor did Cameron in his opening remarks to a crowd of at least 60 who came to hear the announcement on the state Capitol lawn.

Representatives from several organizations were on hand to support the initiative, including the Veteran Mental Health Leadership Coalition, Reason for Hope, Heroic Hearts Project, Veterans Exploring Treatment Solutions and the Foundation for a Healthy Kentucky.

“I am so excited to support Kentucky in this innovative ibogaine research initiative; it’s second to none,” said retired Marine Corps Lt. Gen. Martin Steele, who is CEO of Reason for Hope and president of the Veteran Mental Health Leadership Coalition. “The existing clinical research and the growing body of personal anecdotes suggest that ibogaine when used with careful medical screening, treatment protocols, and oversight, has incredible promise for treating veterans and all others struggling with opioid addiction.”?

With great emotion, several people shared their stories of addiction — and recovery after being treated with ibogaine in a country where it is legal.?

One was Bobby Laughlin, CEO of New Course Enterprises, a California investment firm, who told how he was able to stay off heroin and other opiates after going through treatment with ibogaine under medical care in 2013.?

Laughlin said ibogaine was key to his survival. He said the drug minimized the physiological feeling of opiate withdrawal, removed his compulsion to use opiates, and induced a spiritual experience, which reinstated compassion and love for himself — and was not a habit-forming medicine, and only needed to be used once.?

Next steps

Hubbard said he envisions the project to legalize ibogaine as a public-private partnership. Asked the basis of his $42 million estimate, he said it seemed to be a “reasonable sum” for a “breakthrough opportunity” that, if successful, would not only have a “profound” impact on Kentucky but the rest of the nation.

He said he will discuss the project with the commission at its June 12 meeting and ask it to set a schedule for how to proceed, including one or two public hearings. Then, he said the commission will work toward taking a vote, “perhaps in the fall,” to commit the funds.

“Work would begin to develop the necessary criteria for the announcement of a grant opportunity . . . for any clinical research team that would seek to come in here to develop ibogaine therapy as well as the best practices model for its application to opioid-use disorder,” he said.

The money would come from the $842 million the state is getting from settlements with drug manufacturers and distributors, half of which has been allocated to the state and the other half to cities and counties.?

Hubbard said, “I want to emphasize that this is preliminary and we are going to explore that possibility. Given the expense — and it is a significant expense of developing any therapeutic to go through the FDA process — we want to make sure that the money we put up to be matched by clinical research teams will be an adequate sum to get us across the finish line.”??

Current treatments have ‘modest’ success

There is no question that Kentucky, and the nation, need to find more effective ways to treat opioid addiction.?

“Existing addiction treatment models have modest success rates,” the news release noted. “Some existing treatments are also subject to misuse. Prevailing opioid-use-disorder treatment models carry an average cost of $139,200 per person per recovery attempt.” The release said that from 2017 to May 26, drug companies billed Kentucky Medicaid $1.02 billion for almost 102 million doses of suboxone, “one of the most common and presently effective medications for treating opioid-use disorder.”?

Cameron said that while overdose deaths dropped 5% in Kentucky in 2022, the bad news is that 2,127 Kentuckians overdosed last year and the number of overdose deaths in the state has risen 60% since 2019 – with 7,665 Kentuckians dying from overdoses in that time, and about 90% of them caused by opioids.

“We’ve got more work to do … and something has to change,” Cameron said. “Obviously, we need to continue to fund the work that has been ongoing in Kentucky. We also need to explore a new approach. We have to imagine new possibilities. We have to invest in programs and potential solutions for tomorrow.”

Among those attending the event was Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky and a former Democratic attorney general and congressman. He applauded the effort, saying the foundation is hopeful for the health benefits this new initiative could bring to Kentucky.

“We support innovative and data-driven methods to solve health problems,” Chandler said in a news release. “This move to explore new treatments to reverse the chemical effects of opioid addiction, including opioid withdrawal, could be the key to unlocking successful recovery and better long-term health for many Kentuckians.”

Hubbard responds to Beshear

Beshear, asked about the endeavor at his weekly news conference, held shortly after the announcement, said he had only learned about the commission’s “psychedelic research” idea that day.?

He said members of the commission from his administration, Health Secretary Eric Friedlander and Van Ingram, executive director of the state Office of Drug Control Policy, said they had not heard about the project.

“They’re supposed to be the ones that decide what projects to fund,” Beshear said of the commission. He also noted that $42 million is more than twice as much as the commission has appropriated in its first round of grants. “This is a huge amount of money,” he said.

Hubbard said in an interview Thursday, that the commission will allocate a total of $30 million by the end of this year. He stressed that it was his idea to explore the use of ibogaine for opioid-use disorder and said he had not formally discussed the initiative with any of the commission members.

“I will take responsibility as chairman for the commission for having conducted individual research in my capacity as chairman for anything and everything that we could possibly discover that could potentially be a breakthrough therapeutic for treatment of opioid disorder,” he said. ” I undertook that effort because the results we are getting with our existing infrastructure are unacceptably mediocre.”?

He added, “The entire point of the announcement yesterday was to present the concept to the commission members, as well as to the state as a whole. Every commission member was invited. … And we did not disclose details in advance because this was sensitive information that was developmental. And insofar as we presented it, we wanted to present it on a wide scale, simply because it’s innovative, it’s new, and we think that it should receive spotlight, celebratory attention.”?

Friedlander and Ingram did not attend.?

Hubbard said he would be “ultra, ultra hesitant” to have any advanced consultations with Beshear’s appointees because he thinks Beshear misrepresented the commission’s work back in January. Beshear said the commission did not have enough guidance or scoring criteria for the grant applications, despite regulations that outlined factors for consideration.

Hubbard said, “I would not be able to have any confidence in the degree to which he, in a context of a press conference, would address it honestly and with good faith.”?

Cameron spokeswoman Shellie May, who was on the call with Hubbard, emphasized that no money has been allocated or decided for the project because that is the responsibility of the commission, which includes two Beshear subordinates.

To Beshear’s comment about “a huge amount of money,” Hubbard noted that $42 million would be 10% of the state’s portion of the expected settlement funds and 5% of the whole amount.

“And if we are successful, then we will have developed a therapeutic which will revolutionize how we treat opioid-use disorder – and reduce over the long term the unbelievable consumption of resources being devoted to the treatment of the acute phase of opioid-use disorder, which is the withdrawal symptoms,” he said. “Those are the straight, cold hard facts. When he gets out and he talks about how this is a tremendous amount of money or somehow depriving other potential projects and resources, he’s not even bothered to do the basic math.”

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

The state is accepting public comments on Beshear's plan to revive dental, hearing and vision Medicaid benefits for Kentucky adults. (Getty Images)

Gov. Andy Beshear has again proposed regulations to expand dental, vision and hearing Medicaid benefits for Kentucky adults, after the legislature ended the expansion by finding earlier regulations deficient.

Each new regulation says why it is “substantially different” from the one rejected by the legislature. Most of the reasons have to do with changes in the services offered under the original and new regulations. This language was necessary because the bill that quashed Beshear’s expansion of dental, vision and hearing services for Medicaid adults requires any new regulation to be “substantially different.”

The bill had an emergency clause, so it became law as soon as the legislature overrode Beshear’s veto. But it also told the Medicaid program to reimburse health-care providers “for services rendered or initiated prior to the effective date of this act,” which was March 29.

The proposal is open for public comment through the end of May.

Each of the new regulations addressing expanded dental, vision and hearing services for adults covered by Medicaid starts by giving reasons they are needed, including concern that failure to implement these services, which have gained federal approval, could result in the loss of federal funds.

They say the regulations are needed to pay providers for these services, and as a way to ensure that appropriate services are being offered in appropriate settings, instead of emergency rooms.

Stewart also noted that it is especially important for people to get dental care from an appropriate provider because dental pain in the emergency room is a gateway “to addiction to pain medication.”

“Offering better and more comprehensive dental services is a way to stop that,” Stewart said. “So literally, it’s a way to save lives and save suffering.”

The regulations say these services will help more than 900,000 Medicaid recipients in Kentucky who are 21 and older return to the workplace.

The governor’s veto of Senate Bill 65 said that in its first two months the dental expansion had served “more than 1,000 Kentuckians in all 120 counties” with “nearly 3,330 dental services, including from a dentist in Clay County, who . . . has provided four sets of dentures for patients and has 44 more sets of dentures in progress.” Clay County is the home of Senate President Robert Stivers, R-Manchester.

Beshear added, “Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place.”

Stewart said that having access to dentures and hearing aids will make the biggest difference because many of the managed care organizations already offer glasses as an extra benefit, but not the others. As an example, she noted that many domestic-violence survivors and crime victims have lost teeth and need access to dentures.

“And that really affected their recovery and their ability to feel great about themselves,” she said. “And also, every time they open their mouths to smile, they have memories of being abused. . . . There are so many populations for where this is a really big deal.”

The cabinet had not responded to a request for comment last week when this story was first reported. Nor had state Sen. Stephen West, R-Paris, the sponsor of Senate Bill 65.

This story is republished from Kentucky Health News.

Attorney General Russell Coleman proposed a $3.6 million opioid prevention program aimed at youth. (Getty Images)

Attorney General Daniel Cameron announced the first 24 organizations to receive more than $8 million in grant funding from the state Opioid Abatement Advisory Commission on Thursday, with 14 of the grants going toward treatment and recovery and 10 for prevention of opioid abuse.

“The opioid crisis lingers and won’t be defeated merely with these dollars,” Cameron said at a news conference to announce the awards. “But for the first time in a long time, meaningful relief is here. For the first time in a long time, we have something to rally around, we have a reason for hope.”

So far, Kentucky is in line to get nearly $900 million in settlements with drug makers, distributors and big retailers.

Cameron has implied he should get sole credit, at odds with the account of Gov. Andy Beshear, who preceded him as attorney general and whose job he wants.

Under state law, half of opioid-settlement money is allocated annually by the commission, which is housed in the attorney general’s office, and the other half is allocated by cities and counties, among themselves. Cameron said he has worked closely with local governments and the legislature to manage these funds responsibly because “Not a dime can be wasted; too much is at stake.”

The money is required to be used for reimbursement of prior expenses and the funding of new programs related to the prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorders or mental-health issues.

Bryan Hubbard, executive director and chairman of the commission, praised the ongoing commitment of commission members, noting that since being appointed in June 2022, they have had 11 town-hall meetings across the state, 10 business meetings and numerous subcommittee meetings.

Asked what was gleaned from the town halls, Hubbard said thousands of people attended them and that they inevitably became a “collective, cathartic exercise in communal grief” that revealed common needs across the state, including child-centered prevention programs and recovery services that include housing, transportation services, life-skill training, educational opportunities and formalized vocational training.

“The organizations that are here … have all been resourced to meet those acute needs based on the collected feedback that we receive from thousands,” Hubbard said.

He said the commission hopes to make its next grant announcements sometime in “early to mid-fall” after considering about 65 applications that are seeking $130 million, with only $30 million available.

Hubbard said they have 200 applications in the pipeline and that the commission is working to provide grant makers who can offer individualized assistance to organizations that are not used to writing grants “to ensure good, full consideration of our grassroots organizations.”

“We will always remember the thousands of lives that paid for the settlement from which these funds come, for it is blood money,” said Hubbard. ” You are here because you are the front line foot soldiers who will get in the streets and get in the hollers and bring Kentucky some unified victory.”

Cameron said, “I’m proud to say that because of this office’s action, with a lot of you all that are here today, Kentucky stands to receive nearly $900 million in settlement from funds from pharmacies, distributors, wholesalers and manufacturers of opioids. This is Kentucky’s share of what is a historic settlement, the second largest such agreement in American history.”

Cameron claims sole credit, Beshear shocked

Cameron is a candidate in the May 16 Republican primary to pick a nominee to run against Beshear, who has nominal Democratic opposition. Last week on WKYT-TV’s Kentucky Newsmakers, Cameron talked about Beshear filing a lot of lawsuits but bringing no settlement money to the state.?

Asked about that Thursday, Cameron said: “We wanted to quit talking about the epidemic and bring meaningful dollars into the state. And we’ve been able to do that. We’re in the process of bringing nearly $900 million into the state. Andy Beshear, when he was attorney general, didn’t bring any money into the state. So this has been about not just talking, again, but taking action so that we can hopefully start to have meaningful change in Kentucky.”

Beshear was attorney general for four years, and such suits usually take many years to litigate. Cameron said, “The fortunate thing is that the settlements that we entered into were separate and apart from the litigation that he was involved in here in Kentucky. And so we had to make a decision about, you know, whether we want to continue to talk as he did for four years in this office, or do we want to bring money into the state, and we chose to bring money into the state.”

Asked at his weekly news conference about Cameron’s comments, Beshear said, “I’m a little shocked that the attorney general would say I haven’t brought any dollars in in opioid settlements. I filed more lawsuits against opioid manufacturers and distributors than any other attorney general in the country. I think he filed one. Every single lawsuit he’s settling right now, I not only filed, but I argued personally in court showing up when companies were trying to blame us, for the millions of pills that they sent, hundreds of thousands into really smart communities.

“Listen, as an attorney, you’re always supposed to share credit with other lawyers on the suit on a lawsuit or especially the ones who filed it. And if you’ll remember, I settled. Actually, Attorney General [Jack] Conway settled the first opioid lawsuit on his way out of office, I was able to award those funds, but we gave credit all the way back to Greg Stumbo, who filed that [suit]. So certainly, first, as attorney general, we did bring in funds to help treatment. Look at Hope in the Mountains in Prestonsburg; it was going to close down without those funds that we provided. Now, they’re Medicaid eligible.

“But, I know I filed those lawsuits. I know I did it so that we could have our best shot of getting out of this epidemic. This is blood money that needs to be spent the right way to get people better.”

The list of grants mentioned specific uses in some cases but not in most. Asked for details, Krista Buckell, communications director for the attorney general’s office, merely parroted the law: “Each awardee will be pursuing one or more aspects of prevention or treatment and recovery for individuals and communities that have been impacted by the opioid epidemic across the commonwealth.”

Operation Unite, Volunteers of America receive $1 million each

By far the largest grants were $1 million each to Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education) of London, for prevention, and Volunteers of America Mid-States of Louisville, for treatment and recovery. The Louisville-based organization says it “operates nearly 50 distinct human service programs in Kentucky, Tennessee, West Virginia and Clark and Floyd counties in Indiana.”

The other 13 grants for treatment and recovery are going to:

• Shepherd’s House of Lexington,a long-term residential recovery program, $141,450.
• Appalachian Restoration Project, a residential rehabilitation facility in Barbourville, $250,000.
• Chrysalis House of Lexington, Kentucky’s oldest and largest residential treatment program that specializes in treating pregnant and parenting women, $250,000.
• Isaiah House,an addiction treatment center with locations across the state, will get $250,000 to support a “comprehensive, dual diagnosis program to help Kentuckians achieve a lifetime of recovery,” the list says.
• Lake Cumberland District Health Department, which serves 10 counties, $250,000.
• Mountain Comprehensive Care Center of Prestonsburg, $250,000.
• Mountain Comprehensive Health Corp., Whitesburg, $250,000.
• Seven Counties Services, a Louisville-based community mental-health center, $250,000.
• Young People in Recovery of Louisville, which serves youth and young adults recovering from substance use disorder, $308,232.
• Family Scholar House in Louisville, which helps disadvantaged single parents and children reach their educational and career goals, $316,500.
• Lake Cumberland Community Action Agency will get $375,268 for “comprehensive programs that help low-income Kentuckians achieve greater economic self-sufficiency.”
• Appalachian Research and Defense Fund of Kentucky, offering free civil legal help to low-income people in 37 counties, $250,000.
• Revive Ministries of Nicholasville will get $500,000 to support its faith-based addiction recovery program in Central Kentucky.

The other nine prevention-service grant recipients are:

• Kentucky Alliance of Boys & Girls Clubs, $500,000.
• Kentucky Harm Reduction Coalitionof Louisville, $500,000.
• Legal Aid of the Bluegrass, $250,000. It provides legal assistance to vulnerable Kentuckians.
• Legal Aid Society of Louisville, $250,000 to provide free civil legal help concerning opioid-specific matters to people with incomes at or below federal poverty levels.
• Cumberland Trace Legal Services, dba Kentucky Legal Aid, Bowling Green, $250,000. It provides free legal counsel to those struggling with addiction.
• YMCA of Greater Louisville, $250,000.
• Prevent Child Abuse Kentucky, Lexington, $243,050.
• Taylor County School District, Campbellsville, $100,000.
• Scott County Sheriff, Georgetown, $92,354.13.

This article is republished from Kentucky Health News.

Beshear called dental, vision and hearing benefits for people on Medicaid a "no-brainer" and "what gets people back to work." (Getty Images)

In October, Democratic Gov. Andy Beshear announced the expansion of dental, vision and hearing benefits for 900,000 Kentucky adults on Medicaid.

On March 16, the Republican-controlled General Assembly took a final vote to take those benefits away, calling the regulation that created them deficient.

Beshear said Thursday that he will find a way to keep the expanded benefits in place.

In presenting Senate Bill 65, Sen. Stephen West, R-Paris, said the regulation Beshear issued to expand these services was deficient because the funding came from $38 million in savings achieved when the state moved to a single pharmacy-benefits manager, a middleman between drug manufacturers and companies that manage Medicaid.

West said using these savings amounted to the governor “appropriating money” and that lawmakers should have been involved in how it was spent.

“It was a huge change, really that should have been done through, we felt, through statute through involving the legislature,” West said at the Feb. 15 Senate State and Local Government Committee meeting.

In October, Cabinet for Health and Family Services spokeswoman Susan Dunlap told the Courier Journal that federal funds would cover 90% of the expansion’s cost. She said the state’s move to one pharmacy-benefits manager last year “has resulted in significant ongoing savings to the Medicaid program that will provide enough funding for this program moving forward.”

As SB 65 went through the legislature, it was amended to extend dental, vision and hearing services through June 30 to allow people already getting the services to receive them and allow providers to be paid.

. . . neither providers nor Kentucky families should pay the price for a political food fight. SB 65 has providers left holding the bag with more Kentuckians losing dental benefits than the total population of Alaska. It's as unwise as it is unfair.

– Terry Brooks, Kentucky Youth Advocates, executive director

The amendment also says nothing in the bill should be construed to prohibit the state Medicaid department from increasing reimbursement rates, long a goal of health-care providers. The Kentucky Oral Health Coalition says Medicaid’s dental provider rates have been stagnant for more than 20 years.

Sen. Stephen Meredith, R-Leitchfield, said a rate hike is especially needed in medically disadvantaged areas. In explaining his vote for SB 65, he also said the momey could have been used to help the 5,000 children who are waiting for services from one of the state’s special Medicaid waiver programs.

“I just want to remind folks that what we’re asking here is for some involvement from the legislature,” Meredith said. “Talk to us. Let us have some input in this.”

What’s next??

Before Beshear’s expansion, these services were offered on a limited basis.

Dental services for adults were limited to an annual cleaning and extractions linked to certain medical conditions. Adult fillings were not covered.

The expansion allowed coverage for fillings, dentures, implants, root canals, extractions, restorations, periodontics and an additional cleaning each year.

Also, under the old rules, a Medicaid enrollee could be evaluated for hearing loss only on referral from their primary-care doctor. Glasses and contact lenses were not covered, though exams were. Some Medicaid managed-care firms offered some of these services as an incentive to get people to enroll with them.

Asked at his weekly news conference Thursday if there is a way to maintain the benefits, Beshear said, “I believe a new regulation will allow for the continuation of vision, dental and hearing benefits. The expansion of those benefits, the funding coming from the federal government is an executive branch function. But even at the hearing, I believe . . .? one of the legislators said it looks like you’ll need a new regulation.”

SB 65 requires any new regulation to be substantially different from the original. If Beshear vetoes the bill, the legislature could easily override the veto.

Beshear called the need for dental, vision and hearing benefits for people on Medicaid a “no-brainer” because “this is what gets people back to work.”

He elaborated:?“There’s a study that talks about over 100 million work hours lost due to … emergency dental procedures that if you have coverage you avoid. Now there are studies out there about the number of people that can’t go to work because we don’t cover getting them a pair of glasses. And then think about safety on the job site. You know a ton of Americans … ?suffer from hearing loss. And to be able to get to the job and to do it correctly, you need to have that type of coverage. Again, if we care about the workforce, right, let’s take the basic steps to get more people healthy (and) back to work.”

?Access to providers

?West also argued that health-care providers tell lawmakers that even if these services are permitted in Medicaid, the program’s reimbursements are so low that it will be hard for the patients to find providers.

That said, the health cabinet says thousands of Kentuckians on Medicaid have already taken advantage of these services since they became available Jan. 1.

?“As of Feb. 22, more than 8,000 Kentuckians — across all 120 counties — have already received dental, vision, and hearing services they need under these regulations,” the cabinet said. “More than 1,000 Kentuckians received nearly 3,330 dental services under these regulations — in all 120 Kentucky counties — including from a dentist in Clay County who since Jan. 1, 2023, had provided four sets of dentures for patients and has 44 more sets of dentures in progress.”

?Clay County is the home of Senate President Robert Stivers, R-Manchester.

?The cabinet added, “Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place. … Providers have received over $1 million in reimbursement for the services.”

Health advocates push back?

Health advocates were disappointed in the bill’s passage and called for legislators to reinstate the services.

“The genesis of this unfortunate piece of legislation is a raw partisan battle between the General Assembly and the governor,” said Terry Brooks, executive director of Kentucky Youth Advocates.

“Both branches of our government should be holding each other accountable when one thinks the other overstepped its bounds. Yet, there should also be no doubt that neither providers nor Kentucky families should pay the price for a political food fight. SB 65 has providers left holding the bag with more Kentuckians losing dental benefits than the total population of Alaska. It’s as unwise as it is unfair.”

In a statement about the passage of SB 65, the Oral Health Coalition cited the great need for comprehensive dental services in Kentucky, noting that the state ranks among the bottom five states on several oral-health indicators and has more seniors with no natural teeth than any other state.

“While it was a worthy debate about the process to expand services, the reality now is that 900,000 low-income, disabled, and other vulnerable Kentucky adults must once again go without critical dental care,” the coalition said. “By no means is this expansion the answer to the growing oral health crisis in Kentucky, but it can offer a first step toward providing comprehensive dental care for Kentuckians. The Department for Medicaid Services and the General Assembly must reach an agreement in the immediate aftermath of the legislative session so our Commonwealth can be back on track to providing folks with the health care they need to be healthy, work, and thrive.”

Emily Beauregard, executive director of Kentucky Voices for Health, an advocacy group, told Kentucky Health News in an e-mail, “Regardless of the politics, it’s clear that Kentuckians don’t have enough access to the dental, vision, and hearing care they need to be healthy. We’ve made progress in recognizing that mental health is health and we need to do the same for our mouths, eyes, and ears.”

She added, “Whether it’s through regulation or legislation, we need policymakers to increase access to these services to improve population health and build a stronger workforce,” she added. With the passage of SB 65, “I hope legislators will take action to increase services through legislation instead.”

This article is republished from Kentucky Health News, an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.?For details, contact [email protected].

James Helmburg of the Kentucky National Guard opens a tent where COVID-19 patients could receive monoclonal antibody treatments at St. Claire Regional Medical Center in Morehead on Sept. 16, 2021. (Photo by Jon Cherry/Getty Images)

(Photo by Jeff J Mitchell/Getty Images)

Kentucky’s local and state governments continue to reap more millions from settlements with drug manufacturers and distributors, and are looking for guidance on how to spend the money to provide relief from the opioid epidemic, as the settlements require.The state is getting $842 million, half of which will be allocated by the state?Opioid Abatement Advisory Commission, with the other half going to cities and counties. Funds are to be disbursed annually, on various schedules, through 2038.

The head of the commission, appointed by Attorney General Daniel Cameron, envisions a practical, strategic, “flexible and dynamic” process. Gov. Andy Beshear and one of his appointees who serves on the commission want firmer guidelines and a scoring system for grant applications.

At the commission’s Jan. 10 meeting, its?treatment and recovery subcommittee set the calendar to start making recommendations for the grant awards, and some members said they need formal guidelines, such as scoring rubrics.

One member said it would be important for the group as a whole to be working from the same guidance. Another said such guidance would allow for transparency and consistency in the selection process.

“We need some common themes from the other groups, as well as ours,” said subcommittee member Van Ingram, director of the Kentucky Office of Drug Control Policy. “I think we need that before we move forward, so, you know, nobody’s rubber-stamping everything that comes through or nobody’s denying everything that comes through; that we have some common themes we want to look at.”

The next treatment and recovery subcommittee meeting is Feb. 7. Ingram said, “If we don’t have the guidance before Feb. 7 or on Feb. 7, I don’t think we need to be making any decisions. We can discuss. We can look at. But . . . we don’t want to make decisions and then the guidance come later.”

Ingram works for Beshear, a Democrat who is seeking re-election. One of the Republicans running to unseat Beshear is Cameron, who named lawyer Bryan Hubbard chair and executive director of the Opioid Abatement Advisory Commission.

Hubbard was asked Jan. 19 if the guidance Ingram wanted would be forthcoming. He said, “This is not a process by which we can use strict, academically developed, rigid rubrics to assess the viability of a project. We’ve got to think practically, strategically. And we’ve got to be able to recognize what is going on, on the ground, so that we can deliver the necessary resources to advise good work that’s being done. The application process that we’ve come up with gives us the due-diligence tools to ensure we have competent qualified organizations who can participate, and we aim to resource as many of them as well possibly can.”

Meanwhile, Kentucky Health News asked Beshear at his regular weekly news conference if he shared Ingram’s concerns, and he said he did. “Certainly any process where there’s an application for government funds, has to have guidelines, has to have scoring criteria,” he said, adding later, “That is a great concern that they have taken all of these applications without giving organizations . . . the scoring criteria that will be used. So my hope is that we’ll see some major changes.”

Beshear alluded to the election: “This isn’t about me or anybody else in office; this is about wanting to make sure that this money, which is blood money, is used the right way, is used the smart way. And if they don’t come up with criteria, how are they going to tell all the amazing organizations that there might not be enough funding for in this round why? . . . They’re going to need an explanation about why one thing was funded and another wasn’t early on.”

Cameron’s communications director, Krista Buckel, said regulations unanimously approved by the commission and signed by Beshear outline how it will review the grant applications.

“The regulations . . . clearly outline factors for the commission to use in reviewing grant applications,” Buckel said. “These guidelines provide the flexibility necessary for the commission to strategically and adeptly respond to the opioid crisis.”

Hubbard told the Health and Senate Health Services committees Jan. 19?that the commission had received 32 completed grant applications and that 231 more are in progress. He said the total asked by the completed applications is $63.6 million.

Local officials also seek guidance

At the Jan. 17 Woodford County Agency for Substance Abuse Policy meeting, County Judge-Executive James Kay told Hubbard that the county and its two cities would like a “free blessing” from the commission saying that a program they are considering falls within the law for spending the settlement money.

“I can tell you already that we’ve already had ideas that people( say), ‘I don’t know if that fits the statute’,” Kay said.

Kentucky League of Cities will be handling questions for the cities and Kentucky Association of Counties will be handling questions from the counties. They would, in turn, contact us.

– Alison Chavies, executive staff advisory, Opioid Abatement Advisory Commission

Hubbard told Kay, “Insofar as that’s an idea that your fellow judge-executives would be receptive to, we would love to assist in any way you think is helpful.”

A few days later, Hubbard told Kentucky Health News, “We want to be supportive without being dictatorial. And insofar as there is anyone within local leadership across the state that wants us to bless anything, it’s not a necessity, but we’re happy to do it with him.”

Alison Chavies, Hubbard’s executive staff advisor, told KHN that all programs and projects using opioid-settlement money must fall within existing statutes and regulations, which are strictly bound to opioid-use disorder or co-occurring substance-use disorder or mental-health issues. Further, she said in an e-mail, “Kentucky League of Cities will be handling questions for the cities and Kentucky Association of Counties will be handling questions from the counties. They would, in turn, contact us.”

Asked if the commission is figuring out things as they go along, Hubbard said, “This is an entrepreneurial endeavor within the framework of government. And we are very much engaged in an entrepreneurial exercise in which we have to be flexible and dynamic.”

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Latest town hall focuses on high overdose rates of Black Kentuckians?

Hubbard told the health committees that in 2021 the overdose death rate was higher among Black Kentuckians than among white Kentuckians for the first time.

“Those deaths are almost exclusively driven by fentanyl, fentanyl poisoning,” Hubbard said. “That began to really show up in state statistics in 2017 and the trend line is a sharp trend line upward. And it is something that we have got to get our hands around and drive awareness of.”

In partnership with Lexington Councilwoman Denise Gray, the commission held its latest town hall at the Consolidated Baptist Church Jan. 17 to address the growing crisis of opioid overdoses in the Black community, Grason Passmore reports for WKYT.

The commission heard from doctors who treat people with substance-use disorders and people who had lost loved ones to the disease.

“When you come into the clinic as someone who is addicted to opioids, there’s already a stigma that you’re trying to get over on someone. We have to get rid of that stigma,” said Quentin Moore, a nurse practitioner.

He added, “Within the Black community we don’t see us as having a problem. Even though somebody just took a pill their aunt was prescribed. They just took the pill because they had back pain. Then they went back again. Then again. And after that, they just can’t stop going back.”

Hubbard told the health committees that common themes in the 11 town hall meetings have been the need for increased prevention programs for youth, creation of recovery support programs, recovery housing, transportation, second-chance employment, expungement of criminal records, acute-phase treatment with seamless transitions to treatment, and addressing the stigma that plagues this disease.

“In our town-hall meetings, it is very clear that Kentuckians wish for those of us who hold public trust to understand the depth and just the immense dimension of pain that exists in the state, that has been produced by this epidemic,” Hubbard said. “We are losing a small town a year and have been for at least a decade.”

The 83-page court document says Express Scripts is “at the center of the opioid dispensing chain.” (Photo by Getty Images)

This article is republished from Kentucky Health News, a publication of the?Institute for Rural Journalism and Community Issues?at the?University of Kentucky.

Kentucky’s cities and counties have received their first installment of the state’s money from the national opioid settlement, most of which must be used to combat the opioid epidemic.

Knox County Judge-Executive Mike Mitchell said he is exploring how to get the most from the $365,000 or so that the economically distressed county in southeastern Kentucky got from the settlements in 2022, including partnerships with other organizations or implementing programs that focus on prevention, education, re-entry and rehabilitation.

Mitchell said any decisions about how to spend it will require input from the community and a Fiscal Court vote. “We will be very cautious about what we do,” he said. “We want the maximum benefit out of this for the community and to make sure that it’s being applied to fill the needs that it is intended for.”

The money comes from a $26 billion settlement with drug maker Johnson & Johnson and the nation’s three top drug distributors, Cardinal Health, AmerisourceBergen and McKesson Corp. Kentucky’s share of the settlement was $478 million, with? half the money going to the state and the other half going to local governments. The state’s allotment will be distributed by the Opioid Abatement Advisory Commission, housed in the attorney general’s office.

Mitchell said that while he is pleased to get help to fight the opioid epidemic, no amount of money will fix the damage that’s been caused by the drug companies.

“It’s unfortunate that Kentucky’s eligible to receive this because there’s no way to replace the damage that’s been done by the pharmaceutical people,” he said. “I feel they’re totally to blame. That’s a big part of our drug problem, in the way this opioid was misrepresented. . . . It’s not an exorbitant amount of money, for the damage that they’ve done. . . . There’s no way to go back and redo the impact that they’ve had in our community.”

Kentucky has been one of the states hardest hit by the opioid epidemic. In 2021, the state recorded 2,250 overdose deaths, with 73% of the deaths involving fentanyl.?

How much did your city or county get??

Every Kentucky county received its first allotment of settlement money in December, ranging from $15,994 in Robertson County to $6.7 million in Jefferson County. The Kentucky Association of Counties has posted online the estimated allocations for every county through 2038.

The Kentucky League of Cities reports that 149 Kentucky cities have received an allocation from the settlement and provides a list of the settlement amounts for each participating city for 2022 and 2023; 28 Kentucky cities have not yet signed on to the settlement participation agreement, but remain eligible. If a city did not qualify for at least $30,000, its allotment was rolled into its county’s allotment.

State law says no less than 85% of the proceeds received by each local government “shall go toward abatement of the opioid epidemic in those communities.” Another statute defines acceptable use of the funds and includes a wide range of criteria and guidelines for reimbursement of prior expenses and the funding of new programs related to prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorder, or mental health issues.

Each year, local governments must tell the Opioid Abatement Advisory Commission how they are spending the money.?

How were the allocations determined?

The amount for each local government was based on “population adjusted for the proportionate share of the impact of the opioid epidemic,” according to a National Opioid Settlement FAQ fact sheet. Impact was? determined by the amount of opioids shipped to the state, the number of opioid-related deaths, the number of people with opioid-use disorder in the state, and each political subdivision’s proportionate share of those numbers.

“Adjustments were made to reflect the severity of impact because the oversupply of opioids had more deleterious effects in some locales than in others,” the fact sheet says. “Ultimately, the model allocates settlement funds in proportion to where the opioid crisis has caused harm.”

Asked for details on how the money was divided between cities and counties, Jennifer Burnett, director of policy, research and communications for the counties association, said they “were assigned a . . . ranking percentage based on three or four data points,” and the money was distributed based on a formula applied by Brown Greer PLC, the settlement administrator. Brown Greer, a Richmond, Va., law firm, did not reply to a request for further explanation.

A stated desire to spend the money wisely

Manchester Mayor Steve Collins was just two days on the job when he told Kentucky Health News that he had already reached out to the attorney general’s office to get details on how settlement money could be spent. KLC estimates that Manchester received $15,587 from the settlement in 2022.

“I think it’s urgent that we spend it, but I also think it’s very important that we . . .? discuss what would be the best way to spend it,” he said. “I think that’s the main issue, making sure we put it in the right direction. Just do not hurry and spend it to be spending it, but spend it to be actually the most beneficial to the community.”

Woodford County Judge-Executive James Kay said his county already had an Opioid Task Force and there may be several initiatives in place or in discussion that the money could help. He said combining money with other organizations could heighten its impact, and said he would ask the public how they would like to see it spent. The counties association estimates that Woodford County received $123,595 from the settlement in 2022.

“We want to make sure that we spend the money wisely, efficiently and effectively,” Kay said.

Versailles Mayor Brian Traugott said he would like to see the city’s settlement money spent on prevention, particularly in finding ways to keep young people busy and off of drugs. In addition, he said it will be important to consider programs that help with “post-treatment” and second-chance employment. KLC estimates that Versailles received $17,551 in settlement funds in 2022.

Traugott added that it will be important to get “boots on the ground” people involved with how to spend the money as a way to make sure “that we are utilizing these funds in an effective way.”

Cameron recently announced additional settlement agreements with Walmart, Teva Pharmaceuticals and Allergan?for their roles in the opioid epidemic. Money from these settlements will also be divided between the state and local governments, with the same requirements.