Kentucky Group Renews Push For Higher Cigarette Tax Wednesday, Oct 18 2017 

A renewed effort to get people to quit smoking in Kentucky is launching Wednesday in Frankfort. Led by the Kentucky Chamber of Commerce, Foundation for a Healthy Kentucky and Baptist Health, at the top of the coalition’s to-do list is to raise the cigarette tax to $1.60 a pack. That’s a $1 increase over the current rate.

“The whole idea is to cut this terribly damaging smoking rate that we’ve got in Kentucky,” said Ben Chandler, chair of the newly formed Coalition for a Smoke-free Tomorrow. “We’re 70 percent above the national average, and [smoking] has tremendous economic damage.”

Generally, a 10 percent increase in the price of a pack of cigarettes could result in a 2.5 to 5 percent decline in overall smoking, according to a policy brief last month in the journal, Health Affairs. That means increasing the tax even by 6 cents could potentially mean 220,000 Kentuckians would stop smoking.

The Coalition for a Smoke-free Tomorrow estimates its proposed tobacco tax of $1.60 would raise $266 million in new state revenue each year. Kentucky’s current cigarette tax is the 43rd lowest in the nation, and even raising it to to $1.60 would put the state below the national average of $1.71 a pack.

The Kentucky Farm Bureau is a main opponent of increasing the state cigarette tax. KFB argues that increasing the tax would mean less revenues for Kentucky because smokers might go to neighboring states to buy cheaper cigarettes.

Neighboring Missouri has the lowest cigarette tax in the U.S. at 17 cents per pack. Virginia’s tax is the second lowest at 30 cents. Thirty-four states have a cigarette tax of $1 or more, including West Virginia, Ohio and Illinois.

Meanwhile, cigars, pipe tobacco, e-cigarettes and “roll-your-own tobacco” are not taxed.

But besides the additional revenue that could come from raising the tax, Chandler said there would be other benefits to the state. He said many companies don’t locate in Kentucky because of the likelihood of having many employees who smoke.

“Businesses lose money on the front end with a lack of productivity and the back end having to pay health care costs,” Chandler said.

According to the Kentucky Chamber of Commerce, companies pay $5,800 more in costs for employees who smoke versus employees who do not. The group says illnesses related to tobacco use and secondhand smoke cause 9,000 deaths each year, and cost $1.92 billion in health care expenditures. Nearly $590 million of those annual costs are covered by Medicaid, the state’s insurance program for low-income and disabled people that is funded through taxpayer dollars.

In 2014, Kentucky spent $39.2 million on tobacco control programs like the toll-free hotline, cessation classes and anti-smoking marketing. That’s almost $20 million less than the Centers for Disease Control recommends the state spend.

Chandler said the group would also like to see a statewide law to ban smoking in the workplace or indoor public places, but such a move is unlikely to get legislative approval. So instead, the group will push counties and cities to enact smoke-free laws.

Law Gives New Tool To Doctors Treating Drug Dependent Babies Tuesday, Sep 19 2017 

Cameron McCoy is a very happy baby. He likes to smile, clap his hands and sit on his mom, Teosha McCoy’s, lap. McCoy is 27 and used heroin for eight months while she was pregnant with Cameron. But Cameron wasn’t born dependent on drugs.

McCoy lives in temporary housing run by Volunteers of America Mid-States for new and pregnant moms in recovery.

“It’s God’s grace and mercy that he didn’t withdraw, and I used the whole time,” McCoy said.

But many babies in Kentucky are not so lucky. Data from the Kentucky Cabinet for Health and Family Services show that last year, 1,200 babies were born with neonatal abstinence syndrome, or NAS, because of opioid drug exposure during pregnancy.

Lori Devlin faces the challenge of treating those babies often in her job as a neonatologist at University of Louisville Physicians practice. She recently helped push through a new law that she said will help her and other physicians better determine if a mother used drugs during pregnancy.

“It’s access to be able to know what the baby has been exposed to,” Devlin said. “Because of all the legal implications, oftentimes we end up not getting the truth, or at least not the whole truth.”

Treating a baby who has the symptoms of NAS isn’t easy; they often suffer from seizures and fever, among other problems. But it’s a little easier if the health provider knows what the baby is detoxing from, or even whether they’re detoxing in the first place. There are many other conditions that have the same symptoms of NAS.

Devlin said there are reasons a pregnant woman would take opioids outside of addiction, including conditions that require pain management, like sickle cell disease, cancer and chronic back issues.

Doctors treating those babies have relied on the mothers to give them that information. But finding out whether someone is using drugs illegally can be tricky.

“It’s a scary situation that if you’re a mom that has just delivered, to say how and when you’ve obtained drugs. You might be thinking clearly or remember, ‘Oh yea, I was on this last month from this doctor,” said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. “Rather than to rely on mom’s corporation, it’s a much better situation to look at the actual documents and know.”

And that data is available via the Kentucky All Schedule Prescription Electronic Reporting, or KASPER. This is a database where health providers legally have to report what controlled substances they prescribe patients.

But until now, access was limited to doctors treating a patient. This didn’t help doctors like Devlin, because her doctor-patient relationship was with the infant. The new law allows Devlin–or any doctor treating a baby they suspect of having NAS–to pull the mother’s report.

Van Ingram said even if a mother doesn’t have a KASPER report, that could be telling, too. And he added the information doctors get from KASPER can’t be used to criminally prosecute a mom.

“Or say it’s a NAS baby but there’s no KASPER report,” Ingram said, “that may be an indicator that mom was using heroin or other drugs off the street.”

Devlin said the opioid epidemic has been a much bigger issue than previous years when other drugs were widely used.

“We had cocaine in the 80s but that didn’t lead to massive withdrawal problems,” Devlin said.

There’s also the question of what the long-term impact will be on babies born with NAS. Researchers know the effect fetal alcohol exposure has on those babies later on in life. But with opioids, it’s a big question mark. Devlin said more research is needed to study the long-term effects.

Corinne Ellis Our New Hero! Tuesday, Aug 29 2017 

Corinne Ellis email reply to Kentucky Governor Matt Bevin: “Do not ever fucking email me again.” … Continue reading →

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Question For Congressman Brett Guthrie. Friday, Aug 11 2017 

Republican Congressman Brett Guthrie held an event at the Elizabethtown, Kentucky Police Department Community Room and took questions from constituents. … Continue reading →

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Anti-Abortion Conference Begins With Tame Protests At Louisville Clinic Saturday, Jul 22 2017 

It was surprisingly quiet outside of the EMW Women’s Surgical Center in downtown Louisville Saturday.

Hundreds of anti-abortion activists were expected in front of Kentucky’s last remaining abortion clinic Saturday as far-right fundamentalist Christian group Operation Save America began its weeklong conference with the stated goal of shutting down the clinic. U.S. District Judge David Hale granted a temporary restraining order on Friday establishing a buffer zone around the clinic to keep protesters from blocking its entrance.

The order affects 10 individuals associated with Operation Save who were arrested at the EMW clinic after protesting in May, as well as any of their associates.

Lisa Gillespie |

Buffer zone outside EMW clinic in Louisville.

The buffer zone isn’t a large area — 15-feet by 7.5 feet — and the only breach of the boundary by anti-abortion protesters was to walk from one side of the clinic to the other. Protesters were set up in front of the buffer zone to the street.

Sarah Dugan, a volunteer who helps escort women between their cars and the entrance of the clinic, said the unusually quiet day was due to increased law enforcement presence. Eight U.S. Marshalls and 15 Louisville Police officers were stationed outside.

“Today was quieter than most Saturdays,” Dugan said. “With the police presence there, everyone was way more cognizant about behavior that could be seen as escalating.”

On a typical Saturday morning, Dugan said there’s at least one Louisville police officer who observes from a parked car across the street from the clinic. She said with more officers on site today, the process was smoother for patients approaching the clinic.

“The police were telling people to ‘move, move, get out of the way,’ when people — some people were trying to get through and there was blocking happening,” Dugan said. “Which is amazing. It’s a luxury for us because typically we don’t have that sort presence at all, and the sidewalk gets very congested and very blocked.”

Jonese Franklin

Law enforcement officials keep the peace as anti-abortion activists protest at the EMW clinic.

Brian Parrish, the chief deputy of the U.S. Marshalls Western Kentucky district, said marshalls will be posted there as long as the temporary restraining order — which created the buffer zone — remains in place.

“We’ve had no issues,” Parrish said. “We’re here to make sure everyone’s rights are preserved, and maintain the integrity of the court order.”

In May, 10 people associated with Operation Save America — formerly Operation Rescue — were arrested for blocking the door to the clinic. The group changed its name to Operation Save America after reports of violence against abortion providers and at clinics were tied to the organization.

Ante Pavkovic, an organizer with Operation Save America, drove from Charlotte, North Carolina to attend the weeklong conference that kicks off Saturday night. He said the buffer zone isn’t necessary because his group and other local anti-abortion protesters will still approach women walking toward the clinic to stop them from going in.

“Our weapons are prayer, speaking, and just being out there where things are happening,” he said. “It’s persuasion and that’s as far as it can go.”

Some protesters just pray, others silently hold signs. Some hand out pamphlets and talk at the patients walking toward the clinic. But Sarah Dugan, the clinic escort, said anti-abortion protesters commonly try to intimidate her and the other volunteers.

Pavkovic acknowledged he does this as well.

Lisa Gillespie |

An anti-abortion protester holds a sign outside the EMW clinic in Louisville.

“Yes, there’s rebukes,” he said. “I preach against this sin. I hate abortion. So the preaching is often fiery, but if babies are actually being killed, it should be.”

About 15 minutes before the clinic opened and patients walked the block toward the clinic, Pavkovic approached a clinic escort wearing a purple vest, standing on the same corner.

“You shouldn’t be working here,” he said to the escort. “Take that dumb purple thing off or better yet, join us. Don’t you care about babies? Do you at least know what abortion really is? And do you actually support murdering and dismembering little babies?”

Most Operation Save conference attendees were due to arrive on Saturday and Sunday, according to Pavkovic. And Dugen said the clinic escorts expect next Saturday to be the most active day of protests.

Ahead Of Anti-Abortion Conference, Louisville Clinic Beefs Up Security Thursday, Jul 20 2017 

The founder of Kentucky’s last abortion clinic said the facility is increasing security ahead of anti-abortion protests that will start Saturday.

EMW Women’s Surgical Center founder Dr. Ernest Marshall said he and other staff have been in close contact with the Louisville Metro Police Department and the U.S. Marshall Service. In a conference call Thursday, Marshall described the difficulty surrounding the choice women make to have an abortion. This, he said, is coupled with the logistical problems for some in getting transportation to the clinic, which in many cases is hours away from their homes.

“After overcoming so much to come to our clinic, our patients are forced to face a final obstacle: the excessive bullying and harassment outside the clinic,” Marshall said. “They come to us already made their decision, and it’s awful that they’re then subjected to the surveillance and humiliation outside our doors.”

Far-right religious group Operation Save America will hold its annual conference in Louisville beginning Saturday, and is organizing protests outside the clinic July 22 and 29.

Anti-abortion group Created Equal also has a permit to play footage of a “live” abortion on a large “JumboTron” screen outside City Hall on July 26, according to the group’s Facebook page.

Vicki Saporta with the National Abortion Federation said it will be critical that police enforce the Freedom of Access to Clinic Entrances (FACE) Act, which prohibits people from blocking access to the EMW Center.

“They’re trying to shut down this clinic and I think they’ll go to whatever extremes they think they need to [and] that they think they can get away with,” Saporta said.

While the FACE Act will technically apply no matter what, currently there’s no buffer zone restriction to limit protesters from filling the public sidewalks in front of the clinic.

In a motion pending in U.S. District Court, U.S. Attorney John Kuhn asked a judge to grant a temporary restraining order under the FACE Act. If the judge grants the motion, it would implement a buffer zone and would mean any violation of the buffer zone would carry with it stricter federal penalties.

A similar measure has been informally discussed in Louisville’s Metro Council, though no official ordinance has been proposed. At a committee meeting Wednesday, members were told LMPD is not planning on using extra police or barriers outside the clinic.

Meg Sasse Stern, an escort who aids women in entering the clinic, said 2,658 patients entering the clinic in the past year took surveys asking for their reactions to the protests outside. Eighty-six percent of patients said they were “disturbed,” in some way, including being blocked, intimidated, shoved or touched. Half felt threatened, unsafe or scared. A third of respondents reported considering confronting anti-abortion protesters.

“Anti-abortion extremists emboldened by the prospect of ending legal abortion in Kentucky are marshalling to stage a massive disruptive action that could threaten patient access to the clinic,” Stern said.

Abortion appointments will go on both Saturdays as planned, despite the protests, according to Ernest Marshall.

In May, 10 people associated with Operation Save America were arrested for blocking the door to the clinic. A Louisville Metro Police Department officer told Metro council members Wednesday that besides those arrests and some property damage last week, there haven’t been any recent incidents at the abortion clinic.

3 Possible Factors Behind Sell-Off Of KentuckyOne Facilities Tuesday, May 16 2017 

It’s been five years since Catholic Health Initiatives tried to bring together high-performing hospitals in Lexington and less successful hospitals in Louisville. And now, the Louisville hospitals are being sold: Jewish Shelbyville, Jewish, Sts. Mary’s and Elizabeth and the Frazier Rehab Institute.

The move was announced Friday and KentuckyOne CEO Ruth Brinkley said in a news release that the decision to sell the facilities was “made with great care and consideration.”

“New owners and operators of the facilities outside of our central and eastern community focus will have the resources and ability to continue to deliver care, support employees and physicians and engage the community.”

Here are 3 likely reasons behind the sale:

  1. The patients. While the University of Louisville hospital has the biggest portion of Louisville’s Medicaid recipients and uninsured, Jewish and St. Mary’s are close behind. A big part of that is because of location. West and South Louisville are home to more low-income people, and there are big health care disparities that run down the middle of Louisville.

Ann Hagan-Grigsby from the Park DuValle Community Health Center said 30 percent of their patients are uninsured. And most patients go to one of these hospitals when they’re sick.  And it’s often only when they are very sick that they go.

“Until then, I’m not going to worry about it because I’m worried about food, shelter, clothing and other societal issues,” Hagan-Grigsby said. “Health care is not the top one on your list. It’s just not.”

And patients who have all those other stressors might forgo preventive care and go straight to the ER when problems arise.

  1. Compared to other hospitals in Louisville and the others KentuckyOne are not selling, these facilities rank low with Medicare, meaning that they’re not paid as much as the higher-ranking hospitals.

Medicare gives hospital star ratings based on a lot of factors. And bad ratings mean that facilities are not paid as much as the higher-ranking hospitals. For example, one such ranking is the percentage of patients who receive an appropriate recommendation for follow-up colonoscopy. The higher the number of people, the better. Colonoscopies can detect cancer, ulcers and other diseases.

A third of patients at Jewish Hospital Shelbyville got a recommendation. Three quarters did at Jewish and St. Mary’s Hospital. That compares to one of KentuckyOne’s successful hospitals in Bardstown, where almost 90 percent of people got that recommendation.

In some cases, a low quality score could mean the patient population is just harder to manage. Hagan-Grigsby with Park DuValle Community Health Center says she doesn’t think this kind of sale would have happened East of that health care divide down Louisville.

“If you have a patient population that’s primarily insured, and tends to be very compliant in terms of accessing care, then your challenges are different,” she said.

  1. KentuckyOne is likely trying to make itself a better buy. Catholic Health Initiatives started KentuckyOne back in 2012 to form a regional health care powerhouse, and did so as well in many other states. In 2015, there were 108 hospitals in 18 states. But last year, they went down to 102 hospitals and also reported $500 million in operating losses. Part of those losses came from decreasing payment rates and the Medicare penalties.

Now CHI is in talks with California-based Dignity Health to merge the companies.

What’s next? KentuckyOne is looking for a buyer of these hospitals. Michael Imburgia runs a specialty heart clinic downtown. Many of his patients use Jewish and the Frazier Rehab Center for care. His main concern is that they stay open.

“My bigger fear, they do take care of a lot of indigent patients, and they don’t just take care of people in Louisville, it’s throughout the state,” Imburgia said.

Medicare Isn’t The Safest Of Safety Nets In Kentucky Monday, May 15 2017 

If you’ve got Medicare insurance, you probably already know this. But if you don’t, you need to know this: It won’t be a relief from high health care costs.

That’s according to a new study out from the Commonwealth Fund.

The out-of-pocket cost for an average Medicare recipient is $3,024 a year, according to the study. That doesn’t include monthly premiums. And Medicare recipients pay on average $1,300 every time they’re hospitalized.

The report out Friday shows that although the program for those over 65 or disabled has a basic set of benefits, the real protection from medical bankruptcy comes with a pricey supplemental policy.

Their research found two-fifths of people with Medicare earn below $24,000 but spend 20 percent or more of their income on premiums with medical care. That includes costs covered by some insurance plans. Recipients’ payments don’t usually go far either, as Medicare excludes dental, vision and hearing coverage.

“Those that can are spending a lot on premiums for their insurance and are still at risk for out of pocket costs, particularly if they have middle or low incomes — meaning incomes in the $20,000 range, $30,000 range or lower — and that’s the majority of Medicare beneficiaries,” said Cathy Schoen, study author and Senior Scholar in Residence at the New York Academy of Medicine.

There is no cap on how much people can spend — a protection people on the individual market gained through the Affordable Care Act. With no limit to what they must pay out-of-pocket, some recipients can’t afford the supplemental plans that offer benefits that basic Medicare does not. Of people living below the poverty limit, 74 percent had no dental insurance during the year and less than half had an eye exam.

The numbers are a reminder that funding even basic level Medicare is important, according to Schoen. That’s done through a tax on employee earnings. By 2024, one in four U.S. residents will be over the age of 65. But there won’t be enough young people in the workforce to pay for those people’s Medicare coverage. The federal pot of money that pays for Medicare is due to run out in 2028.

That year was even sooner when the Affordable Care Act passed. But the ACA — also known as Obamacare — put more money in the Medicare fund. One of those things was a 0.9 percent income tax on people earning more than $200,000 a year.

In the House GOP’s American Health Care Act, that tax would be repealed. The Senate is now working on its own repeal and replace legislation, and it’s unclear if that tax repeal will be in it.

Many Medicare recipients in Kentucky area are also in the Medicaid program because they earn less than 138 percent of the poverty limit. In addition to the lack of dental and vision benefits in Medicare, the program also does not pay for nursing homes and long-term care. Medicaid picks up that tab.

Schoen with the Commonwealth Fund said that’s also why an awareness of Medicare’s flaws is important. That shines a spotlight on the repeal and replace legislation, because GOP legislators might change the way Medicaid is paid for, limiting the amount of money a state would get.

“If the state has less federal money to support those services, it could mean either cutting back on the number of people who are eligible, paying providers less or cutting back on benefits,” Schoen said.

Kyeland Jackson contributed to this report.

This story has been updated.

KentuckyOne Selling Off Louisville Hospitals, Group Practices Friday, May 12 2017 

One of the biggest health care operators in Louisville is offloading four major hospitals and six physician group practices.

KentuckyOne Health announced Friday that Jewish Hospital, Frazier Rehab Institute, Sts. Mary & Elizabeth Hospital and Jewish Hospital Shelbyville will all be sold.

“This decision has been made with great care and consideration. New owners and operators of the facilities outside of our central and eastern community focus will have the resources and ability to continue to deliver care, support employees and physicians and engage the community,” said Ruth W. Brinkley, president and CEO of KentuckyOne Health via news release. “We understand this will bring change and questions to our employees and community partners. We have an extensive transition program underway to ease the change and ensure focus on our priories to our patients and our partners.”

Physician group practices in the KentuckyOne Health and Saint Joseph Martin’s Medical Group, Medical Centers Jewish East, South, Southwest and Northeast will also be sold off.

KentuckyOne was formed five years ago with the merger of Jewish Hospital and St. Mary’s HealthCare in Louisville. It quickly started buying up other hospitals and physician practices as the Affordable Care Act was implemented.

In December, KentuckyOne and University of Louisville Hospital announced the end of their joint operating agreement. Officials said the University Medical Center would take over operations of U of L hospital this year.

Heart Of The Matter: Needle Drug Use Brings Spike In Heart Infections Monday, May 8 2017 

The Ohio Valley’s addiction crisis has brought another health problem, as rising numbers of needle drug users are contracting a serious form of heart infection called endocarditis.

The rate of endocarditis doubled in the region over a decade, and many patients require repeated, expensive treatment and surgery as they return to drug use and once again become infected.

According to the Centers for Disease Control and Prevention, annual Medicaid spending on endocarditis is more than $700 million, a number likely to rise if treatment does not change to also address the growing health impact of substance abuse.

Doctors at the University of Kentucky are creating a team approach to address endocarditis and the addiction contributing to it. It’s a challenge that has forced them to change traditional practices, break down walls between different medical practices, and get to the heart of the problem.

Mary Meehan | Ohio Valley ReSource

Sharing or even reusing syringes can build up the bacteria causing endocarditis.

An Emerging Problem

Endocarditis is a result of bacteria accumulating around and infecting a heart valve. It can appear initially as mild, flu-like symptoms or chest pains and extreme discomfort. Emergency surgery to replace heart valves is required in the most extreme cases, but standard treatment involves weeks of sustained doses of antibiotics to make sure the infection is completely cleared.

Mary Meehan | Ohio Valley ReSource

University of Kentucky researcher Jennifer Havens documented a spike in endocarditis cases.

Since 2008, University of Kentucky researcher Jennifer Havens has tracked the health of hundreds of addicts in Hazard, Kentucky. She said that in the last few years she’s seen a spike in endocarditis cases.

“They may or may not be sharing needles but they’re reusing the same syringes, which accumulates bacteria, which they’re basically shooting into their bodies,” she said.

Havens said traditional cardiac units aren’t designed to treat addiction so the patients frequently return to previous, dangerous habits.

“If you’re not treating their substance abuse issue in the hospital they can potentially go right back out and infect themselves,” Havens said.

According to the CDC, addicts with endocarditis are 10 times more likely than other patients to die or require a second surgery months after initially leaving the hospital. Research has also shown that addicts tend to leave the hospital more often before the weeks-long series of antibiotics that is necessary to complete treatment.

Alexandra Kanik | Ohio Valley ReSource

In many cases, the patients are in withdrawal from opiate addiction during treatment. The intense atmosphere of post-surgery care only amplifies the anxiety and pain of withdrawal from opiates, said UK infectious disease specialist Dr. Saritha Gomadam.

“It definitely affects us,” she said. “Our heart just goes out when we see a really young patient in their 20s crying that they want to quit.”

Overall, the median age of endocarditis patients is rising slightly. But at UK and other hospitals treating a large population with substance abuse disorders, it is younger patients who are more often returning in need of multiple surgeries. Gomadam said the question of how to treat them most effectively “is something we talk about almost every time we are on service.”

“There is sort of a moment where you both sit there and you know you have to do something,” she said.

There are also physical limitations to how much the body can take.

“Any kind of surgery has its risks,” she said. “There comes a point where there’s only so many times that their body can be opened up.”

The scar tissue from repeated surgeries can make valve replacement difficult and dangerous.

Teachable Moment

When the patient comes into the hospital with endocarditis it offers an opportunity for the team to have a discussion about substance abuse treatment, said Dr. Laura Fanucchi, who specializes in internal medicine and addiction. She is working with Gomadam to create the new treatment method.

“I believe — and our data support this — that coming to the hospital being very sick from a complication from untreated substance abuse disorder or untreated opioid addiction can be a moment where we can really reach that patient and help them start positive changes,” said Fanucchi.

UK Hospital

Dr. Laura Fanucchi said addiction treatment “has been siloed from general medical care.”

But addressing the social challenges around addiction requires skills outside of traditional endocarditis treatment.

“If we don’t work together we are not going to be successful because the patient has problems that my antibiotics will not cure,” said Gomadam.

Gomadam and Fanucchi are in the early stages of creating a unique team approach for endocarditis after seeing the same young, addicted patients again and again.

“We are working closely with internal medicine, cardiology, cardiothoracic surgery,” Gomadam said, with each group bringing in a particular expertise.

Breaking Silos

Such an approach requires education for both patients and providers.

“A lot of patients with untreated addiction feel very stigmatized by the health care community,” Fanucchi said.

That distrust can result in patients being even reluctant to say they have a problem abusing drugs.

On the other hand, health providers often see the ravages of addiction but very few people in recovery. That takes its own toll, especially on health care providers.

“I think seeing for a long time the complications of untreated substance use disorder some health care professionals start to feel hopeless, and that will engender a culture of frustration,” Fanucchi said.

Alexandra Kanik | Ohio Valley ReSource

She said the answer lies in creating communication across medical and addiction services that have traditionally operated independently of each other.

“I think it’s longstanding in treatment of addiction that it has been siloed from general medical care,” said Fanucchi. “It’s not historically been part of general medical education and residency. So we’re going to address that.”

The approach has been well received, she said, but it is a big shift that will take time.

Fanucchi said another key in finding the right treatment focus is recognizing the need for sustained medical intervention and recognizing relapse as a part of the disease process.

“Trying to be successful, particularly with opioids, with detox only or abstinence only is part of the reason that we are in this problem that we are in, unfortunately,” she said.

That means bridging the hospital stay with drugs that help with withdrawal, such as naloxone and buprenorphine, plus counseling or treatment.

“The analogy is that someone comes into the ER sick from diabetes and you send them home and tell them not to eat sweets but don’t give them any insulin,” she said. “And we wonder when they come back why their diabetes is a problem again.”

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