Require all to have a prescription for pseudoephedrine, or just meth criminals? Officials debate the issue on KET

By Tara Kaprowy
Kentucky Health News

If something isn't done now about the prevalence of methamphetamine in Kentucky, "We're going to lose a generation." That was one of the jarring comments from one of the public officials who discussed ways to limit access to pseudoephedrine, the key ingredient in meth, Monday evening on KET's Kentucky Tonight.

The issue is one of the most contentious in the legislative session that began last week. There are two bills on the table aimed at quashing the problem, both sponsored by House Democrats.

Rep. Linda Belcher of Shepherdsville would make pseudoephedrine available only by prescription, but exempt the gel-cap version of the decongestant. Her bill would expire in three years, to give legislators an opportunity to assess its effectiveness.

Rep. Brent Yonts of Greenville would merely require the 5,500 Kentuckians who have already been convicted on a meth-related charge to have a prescription for the drug.

Belcher argued on the program that Yonts' bill "doesn't go far enough, it doesn't do the job," because meth cooks can pay others to buy the drug over the counter, while Yonts said his bill is a "middle ground" compromise. He asked, "Do we punish the whole population of Kentucky or do we punish those who have violated the law?"

Clay County Sheriff Kevin Johnson called into the program and sided with Belcher, saying "As far as putting the crooks on a banned list, that's not going to help the problem." Chris Cohron, Warren County commonwealth's attorney, said officers with the Kentucky Narcotics Officers Association "overwhelmingly support" Belcher's effort.

Maj. Tony King of the Jefferson County Sheriff's Office took an opposing view In order for pseudoephedrine to be made available only by prescription, it must be reclassified as a legend drug, he said, but those drugs are not tracked by MethCheck — the system that instantly tracks pseudoephedrine purchases at the point of sale — but by KASPER, the state's slower system for monitoring prescription drug abuse. "We will lose the ability to track these people and we will lose the ability track these labs," he said.

Meth-lab numbers continue to go up in Kentucky, reaching nearly 1,100 in 2010. Cohron said that is not the case in Oregon, one of two states that has passed a prescription law. He noted that in 2004, there were 472 labs in Oregon and 571 in Kentucky. In 2010, there were 13 in Oregon, and nearly 1,100 in Kentucky. Still, Yonts said Belcher's bill would punish people in all Kentucky counties for the problems of a relatively few counties.

Yonts argued MethCheck is working now, and his bill would merely strengthen what's in place. He said MethCheck stopped more than 14,000 attempts to buy pseudoephedrine last year. "All our surrounding states will very quickly have our system," he said. "CVS and Walgreens will inter-connect. It's a system that instantly verifies. It works." Cohron countered that 100,000 attempts were blocked in Oklahoma, which has a similar system, "but meth labs are still going up by 10 percent a year there. "Being reactive instead of blocking it is not going to solve the problem," he said.

Some callers to the show said Belcher's bill should not exempt gel caps, from which pseudoephedrine is more difficult to produce. Belcher acknowledged her bill is also a compromise and that 97 percent of meth labs use the pill version. Yonts said exempting the gel caps "just opens the door to another problem."

Panelists also discussed the issue of cost. Yonts said the state stands to lose up to $1 million in tax revenue if pseudoephedrine is reclassified as a legend drug, because prescription medication is not subject to sales tax. Belcher said the cost will be far greater, $1 million in manpower alone. "If we're looking at a tight budget, I'd certainly like to take that $1 million and use it for something that is more productive," she said.

Both Yonts and Belcher said they expect their bills to be heard in committee soon. In the meantime, Cohron, who said a generation is at stake if nothing is done, underscored the importance of dealing with the issue without being romanced by drug companies and lobbyists. "We're talking about a billion-dollar industry," he said. "They will spare no expense and they will stop at nothing to defeat it because it a billion dollars on the line."

To watch the show via KET videostreaming, click here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Beshear says no for second time to University Hospital merger

For the second time, Gov. Steve Beshear has rejected a proposed merger for Louisville's University Hospital, saying he still didn't think ideas suggested in a meeting last week would be enough to allay his concerns. Beshear said no to a controversial proposal Dec. 30 that would have merged University Hospital with Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System.

Beshear would not go into details about what ideas University Hospital officials presented last week, saying only that he remains "committed to working with the university to explore all appropriate paths forward for the hospital and for our Kentucky taxpayers," Patrick Howington and Laura Ungar report for The Courier-Journal.

The merger would have give majority control to St. Joseph, which is owned by Catholic Health Initiatives, so all three health systems would have been subject to Catholic health directives. Jewish & St. Mary's and St. Joseph announced last Friday they will merge without University Hospital and call the system KentuckyOne Health. Beshear said he rejected the merger because it would mean the loss of control of a public asset and raised "constitutional church-and-state issues," Howington and Ungar report. (Read more)

C-J finds gaps in medical care for female soldiers, vets

Though women now account for almost 15 percent of active-duty troops in the U.S. military, the medical care they receive is often not on par with that of their male counterparts.

A 2007 Department of Defense report showed that "In half of focus groups, women expressed concerns about a lack of female-specific facilities and equipment, such as machinery to perform mammograms, in field hospitals," The Courier-Journal's Laura Ungar reports. Department of Veterans Affairs "hospitals don't provide obstetrics, for example, and most don't offer mammograms on-site."

Military officials acknowledge more needs to be done, but progress is being made. "Are we perfect? No. But we work our hardest to be," said Laura Boyd, public affairs officers for Fort Campbell's Blanchfield Hospital.

Efforts are being made to boost privacy for women and improve training. The VA has also hired managers to handle women's care and has launched an awareness program in which employers are reminded to assume that any woman who walks in is a veteran. Spending has also gone up, with the VA asking for $270 million in 2012, up $28 million from last year.

Still, the 2007 report found medical care was wanting in field centers. Women complained "about limits on access to gynecological exams, procedures and lab tests; and too few birth-control options in field pharmacies," Ungar reports. "In nearly half the focus groups, women said there was too little privacy in field facilities, and many felt they were seen as whiners for seeking care."

Officials at Blanchfield admit they can't provide all the care women need and do rely on outside providers, such as Vanderbilt University, for complicated cases and for routine wellness services. Most outside providers are within an hour's drive of a VA facility, which Patty Hayes, the VA's director of women's health, acknowledged is "not ideal." Still, there are no plans to provide obstetrics or other specialty care for women at VA hospitals. (Read more)

Penny-per-ounce tax on sugar drinks could save $17 billion, cut consumption and prevent disease and death, academics say

More than $17 billion in medical costs over 10 years could be saved if sugared drinks were taxed at 1 cent per ounce, and it would prevent 95,000 cases of coronary heart disease, 8,000 strokes and 26,000 premature deaths, say researchers at Columbia University and the University of California.

The tax would mean an extra 12 cents per can or 20 cents per bottle, and would generate about $13 billion in annual tax revenue. The study, published in this month's HealthAffairs, found the consumption of sugary drinks, including soda, sports drinks like Gatorade and energy drinks like Red Bull, would be cut by 15 percent among adults ages 25 to 64.

"Even our conservative estimates show that a penny-per-ounce tax on sugar-sweetened beverages could substantially reduce the negative health and financial impacts of obesity, diabetes and cardiovascular disease," said Dr. Y. Claire Wang, assistant professor at the Mailman School of Public Health at Columbia  and lead author of the study. "Putting the money raised by the tax into efforts to prevent obesity and other health problems could potentially increase the impact of such a policy."

In 2009, Americans consumed 13.8 billion gallons of sugar-sweetened beverages, which translates to about 45 gallons per person. The average 20-ounce bottle of a sugar drink contains almost 17 teaspoons of sugar. (Read more)

Ky. Citizen Doctor of the Year nominations being accepted

The Kentucky Academy of Family Physicians is accepting nominations for Kentucky's Citizen Doctor of the Year award. Patients are encouraged to send in their recommendations by Feb. 1.

The award honors an outstanding, community-minded family physician who provides compassionate, comprehensive care. Candidates should be role models of their profession and of their communities. They must also be members of the academy.

Kentuckians wishing to nominate should send a letter (two-page maximum) that includes the nominee's name, office address and phone number and reasons why the nominee has earned the award to: Kentucky Citizen Doctor of the Year, c/o KAFP, PO Box 1444, Ashland KY 41105-1444. They should also include their own contact information, including email. For more information about the academy, click here.