www.wvgazettemail.com Health http://www.wvgazettemail.com Gazette archive feed en-us Copyright 2017, Charleston Newspapers, Charleston, WV Newspapers DHHR: WV medical marijuana law will need $2 million in upfront costs http://www.wvgazettemail.com/article/20170918/GZ0101/170919650 GZ0101 http://www.wvgazettemail.com/article/20170918/GZ0101/170919650 Mon, 18 Sep 2017 18:25:24 -0400 Erin Beck By Erin Beck State officials estimate they will need about $2 million in one-time, upfront costs to implement West Virginia's medical marijuana law.

Dr. Rahul Gupta, state health officer, gave lawmakers that figure during a meeting of an interim health committee, containing members of both the state Senate and the House of Delegates, at the state Capitol Monday.

Gupta, who is also commissioner of the state Department of Health and Human Resources' Bureau for Public Health, told lawmakers that the DHHR estimates the law, which passed earlier this year, will cost $2 million up front.

DHHR Cabinet Secretary Bill Crouch's office and Gov. Jim Justice's office are working on finding the money, possibly through an "internal loan," Gupta said.

"We would need your help to allow that money to be paid back through legislation," he told lawmakers.

The West Virginia Legislature passed Senate Bill 386, allowing doctors to recommend medical marijuana for the treatment of certain "serious" medical conditions and tasking DHHR's Bureau for Public Health with regulatory oversight, in April. Lawmakers did not provide start-up costs.

Gupta said the DHHR estimates it will cost about $800,000 to $1 million to oversee the medical marijuana regulatory system in the state each year after that. He said those costs should be paid with revenue created by the law, which sets taxes and fees.

About $700,000 for a "seed to sale" tracking system will be the largest single expense in the $2 million.

"In that tracking system, everything from the birth of the seed to the dispensing of the drug will all be controlled," Gupta said.

State officials posted a job listing for the director of the office of medical cannabis on Monday. The director would oversee medical marijuana research as well as operations of the state's regulatory system. They would report to a DHHR deputy commissioner.

"Our hope is to get someone who has some experience," said Barbara Taylor, DHHR deputy commissioner for health protection, noting that medical marijuana is not an expertise of the office.

Lawmakers also tasked the DHHR with creating an online source of public information. That website now has a new address - medcanwv.org.

Gupta noted that DHHR has received calls about the bill every day since passage.

"The human side of it, you can't ignore that piece," he said. "Science explains some of it, but not all of it."

Gupta also pointed to the potential economic impact.

"Rarely are there policies enacted that are win-win," he said. "If it's done right, you can actually get a true win-win on this."

Delegate Jim Butler, R-Mason, asked whether DHHR had received any guidance from the federal government.

Gupta referred to an Obama-era 2013 Department of Justice memo that said jurisdictions that have enacted "strong and effective" regulatory and enforcement systems are less likely to threaten federal priorities and that focusing on seriously ill people "likely was not an efficient use of federal resources."

"That's about all the guidance we have so far," Gupta said, adding that he understood the 2013 memo was still in effect.

State officials also said the medical cannabis advisory board plans to meet in other areas of the state, to give people outside of the Kanawha Valley a chance to give input. The first meeting was held in Charleston last month and the next meeting is scheduled for Oct. 11 in Charleston at the same location, the Erma Ora Byrd Gallery at the University of Charleston.

The board is charged with reviewing applicable laws and making recommendations, such as whether to change the form of marijuana permitted, to the governor and Legislature.

The law states that patient and caregiver ID cards won't be issued until July 2019.

Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.

Capital High closed for the week after high mold, C02 levels found http://www.wvgazettemail.com/article/20170918/GZ0114/170919657 GZ0114 http://www.wvgazettemail.com/article/20170918/GZ0114/170919657 Mon, 18 Sep 2017 16:44:15 -0400 Ryan Quinn By Ryan Quinn Capital High will be closed the rest of the week after test results, received Monday, showed high levels of mold and carbon dioxide in a little less than a third of the school, said Kanawha County public schools Communications Director Briana Warner.

Warner said the goal is to reopen the school Monday, following cleaning from Charleston-based ASTAR Abatement & Insulation.

"The reason for the closing is basically so that our abatement crews can get in here and do their work as quickly as possible," Warner said.

She said there hasn't been an influx of students reporting issues.

Warner said air testing was done Aug. 29 and Sept. 6-8, and Teays Valley-based Pinnacle Environmental's results came in late this morning. Capital students attended classes Monday and were dismissed at their regular time.

She said Pinnacle Environmental will do testing again at the end of the week, and Capital's principal will inform parents by Sunday on whether the school will reopen Monday.

Athletic practices and other events are expected to continue throughout the week.

Warner said the school system currently doesn't know the reason for the mold and carbon dioxide issues, but the first thing that's being checked is the heating, ventilation and air conditioning system.

Capital was among 14 Kanawha public schools that were still undergoing or in need of work on their HVAC systems just three weeks before the start of this school year, according to a July 20 report.

Terry Hollandsworth, the Kanawha schools maintenance director who deferred all comment to Warner Monday, said July 20 that the chiller at Capital is about three decades old and uses a type of freon that's very expensive to replace.

"We have to rebuild the chiller every 10 years," he said. "The gaskets inside of it start leaking. We're in the process of rebuilding 50 percent of it at a cost of $75,000."

At the end of the first week of last school year, Kanawha closed seven schools, including Capital and three more of the county's eight public high schools, due to AC and power failures, meaning about one in 10 Kanawha public schools were closed that day.

Reach Ryan Quinn at 304-348-1254, ryan.quinn@wvgazettemail.com, facebook.com/ryanedwinquinn or follow @RyanEQuinn on Twitter.

Air board refuses to hear concerns over Institute methanol plant http://www.wvgazettemail.com/article/20170918/GZ0101/170919661 GZ0101 http://www.wvgazettemail.com/article/20170918/GZ0101/170919661 Mon, 18 Sep 2017 15:45:01 -0400 Ken Ward Jr. By Ken Ward Jr. Members of a state board on Monday refused to hear a permit appeal from a citizen group that is concerned that potential fires, explosions or other accidents at the US Methanol plant under construction in Institute could pose health and safety risks for area residents.

The West Virginia Air Quality Board granted the Department of Environmental Protection's motion to dismiss an appeal that the group People Concerned About Chemical Safety filed, agreeing with the DEP that the issues raised were beyond the scope of the state agency's job. The decision means the board won't hold a full hearing with testimony about the citizen group concerns.

In arguing against the appeal being dismissed, Bill DePaulo, attorney for the People Concerned organization, urged the board members to make clear what ruling for the DEP's motion would be saying to the public.

"Win or lose, I'd just like a clear ruling," DePaulo told board members. "Do it in big, bold letters: 'We do not consider the human health and safety in issuing this permit.' "

US Methanol hopes to start production in mid-2018 at the plant that would convert natural gas to methanol, a common industrial feedstock. The facility, located at the Institute property now operated by Dow Chemical, would use parts from a deconstructed plant in Brazil.

A variety of political leaders, including Gov. Jim Justice and Kanawha County Commission President Kent Carper praised the project, which promises 60 permanent jobs, during a groundbreaking ceremony two weeks ago. Construction had already begun, despite the pending challenge to the project's air pollution permit.

In the permit appeal filed in April, People Concerned argued that the DEP's Division of Air Quality did not examine the potential consequences for the surrounding community of a spill, leak, fire or explosion at the US Methanol facility.

The citizen group had planned to present an expert to testify to the board about what could happen if one of the facility's largest tanks - holding up to 1.2 million gallons of methanol - explodes. The expert, James Rogers of West Texas A&M University, said in an affidavit that the risks associated with the facility include "catastrophic explosions" and that "critical safety features" to prevent such incidents were not included in the DEP-approved permit for US Methanol.

The appeal also expressed concern about the potential effects on the health of nearby residents from routine emissions from the facility. It also urged the DEP to collect baseline public health data in the area before allowing US Methanol to begin operations.

DEP attorney Jason Wandling told the board that such issues are beyond the limits of what his agency regulates under the state Air Pollution Control Act. Wandling said the People Concerned group was pushing for a broad reading of the state's air pollution law, while the DEP focuses on specific statutory duties that spell out specific actions the agency is empowered to take.

Wandling compared what the citizen group was asking the DEP to do to the agency deciding to ban smoking because it is harmful to human health.

"If we tried to incorporate any of the provisions appellants ask for, [US Methanol] would be challenging those requirements, and [the] DEP would almost certainly lose that appeal," Wandling said.

Dave Yaussy, a lawyer for US Methanol, read a long list of local, state and federal agencies that he said are charged with dealing with the safety of plants like US Methanol.

"There is no need for DAQ to duplicate those efforts," Yaussy said. "If the board agrees to hear this appeal, it is rewriting the state's Air Pollution Control Act."

DePaulo reminded the board that the Institute plant is located adjacent to a historically black university, and that other parts of the property were home for many decades to a huge stockpile of methyl isocyanate, or MIC, the chemical that killed thousands of people in a December 1984 leak at a Union Carbide plant in Bhopal, India. And the Institute plant itself, DePaulo reminded the board, has had plenty of serious leaks, fires and explosions over the years.

"It doesn't take someone who is paranoid or delusional to imagine the circumstances under which this particular facility could cause a very significant threat to health and safety," DePaulo said.

The board heard about 20 minutes of arguments on the DEP's motion to dismiss, and then went behind closed doors for more than 45 minutes to deliberate on the motion.

When board members returned to the public session, Chairman Michael Koon said the board was "very sympathetic" to the citizen concerns but that the issues "are not in the purview" of the DEP.

Koon said the board had reached a "consensus," but that the decision was not unanimous. He did not provide a vote count or specify which board members voted which way. Other board members taking part in the meeting were Grant Bishop, Stanley Mills, Tom Hansen and Jon Hunter.

Reach Ken Ward Jr. at kward@wvgazettemail.com, 304-348-1702 or follow @kenwardjr on Twitter.

Death of teenager reveals shortfalls at Charleston facility http://www.wvgazettemail.com/article/20170916/GZ0115/170919717 GZ0115 http://www.wvgazettemail.com/article/20170916/GZ0115/170919717 Sat, 16 Sep 2017 15:09:48 -0400 Giuseppe Sabella By Giuseppe Sabella Staff members at a Charleston care facility often lost keys before a boy stole the facility's van and died in a wreck earlier this year, and an employee lied about checking on the boy just before he died, a state investigation has found.

Jeremy Bush, 13, lived at Woodward Children's Home, which is residential facility operated by ResCare, a company based in Louisville, Kentucky. Bush took the keys to a van and then crashed into a stone retaining wall. An employee later estimated Bush's speed at 70 miles per hour, according to a report from the state Office of Health Facility Licensure and Certification.

"As I made that snake curve I saw the van standing engine down and the back of the van positioned up and on fire," the employee was quoted as saying in the OHFLAC report.

ResCare, among other services, provides residential care to children with extreme mental and physical disabilities.

Employees lost the van keys two or three days before Bush's death, and the keys reappeared on the day he died, according to the report.

The home required employees to secure vehicle keys in a lockbox. However, staff members sometimes failed to follow procedure, the report states.

One employee said the facility's vehicles stayed unlocked while parked in the driveway, according to the report. Investigators found an unlocked vehicle at the home two days after Bush's crash.

When the staff did secure keys in a lockbox, they opened it with a "1-2-3-4-# or 1-2-3-4-* code," according to the report.

The facility housed four clients before Bush's death. In the report that followed, investigators declared the residents' health and safety were in "immediate jeopardy."

As part of an emergency plan of improvement, management agreed to make the code more complicated. Employees are also required to place vehicle keys in the lockbox, and to secure the lockbox key in a separate location.

ResCare clients require constant supervision. Employees have slept in the hallway to stay near residents' bedrooms, according to the report.

Still, the report said Bush escaped twice before the crash that led to his death.

On Jan. 29, he pushed out a window and left the home. According to the reports, it's not clear if employees notified Bush's guardian.

The employees then installed an alarm on Bush's bedroom windows - but he could still turn off the alarms or remove their batteries.

Bush then tried and failed to escape through a bedroom window on Feb. 7. Instead, he left on a bike and traveled to a convenience store, the report states.

Surveyors said the facility never identified Bush's behavior as a risk in his official support plan.

The home's new policy requires a tamper-proof alarm on every bedroom window, according to the report. "Staff will open and close windows daily to ensure that the alarms are working properly," the report states.

Along with providing constant supervision, ResCare employees are tasked with documenting daily activities. But staff members at the children's home failed to complete a form each time they left or returned with a child or vehicle, according to the report.

An employee last signed the vehicle sign-out form on March 12, even though someone used the van three days later.

One staff member lied on Bush's sleep chart the night of his death, according to the report.

According to the chart, she saw Bush awake at 8:15 p.m. The employee actually left her shift an hour early, at 7:01 p.m., according to the report. Bush crashed the van about 45 minutes later.

In their report, investigators said the faked chart made them question "the validity of other documentation completed by facility staff."

As a result of the investigation, the home's residential manager will now make random visits to the home. The clinical supervisor is responsible for reviewing incidents and ensuring that each report is investigated. There will also be a safety meeting each month, when the staff will review incidents and try to identify ongoing problems.

Investigators visited the home on April 25 and completed a follow-up report. They found no deficiencies, meaning the facility is in "substantial compliance" with federal regulations, according to an email from Allison Adler, a spokeswoman for the state Department of Health and Human Resources.

Adler said the job of OHFLAC investigators is to make sure health centers are following regulations and policies. "If OHFLAC determines referrals are necessary to law enforcement or professional boards, these referrals are made," she wrote.

Sgt. Mark Kinder of the Charleston Police Department announced an investigation after Bush's death in March. Kinder was unavailable for comment.

ResCare will not say whether it disciplined any employees of Woodward Children's Home. "We can't comment directly on employment questions due to privacy concerns," said Kristen Trenaman, a spokeswoman for the company, in an email.

She said ResCare investigated Bush's death in hopes of improving the quality and safety of his former home.

"We are deeply saddened when harm comes to any individual we serve," Trenaman wrote in the email.

Woodward Children's Home is among several ResCare facilities to face scrutiny in West Virginia. OHFLAC confirmed at least 30 complaints among 10 ResCare agencies in the state between 2012 and 2016.

The health department called on ResCare officials to gather in West Virginia for a meeting in April. State officials intended to "address the serious issues raised in the Gazette article," according to an internal email.

In a recent email, Adler said officials used the meeting to push for changes at ResCare.

"We continue to explore options available to help prevent these tragedies from happening in the future, including possible statutory changes," she wrote.

Reach Giuseppe Sabella at giuseppe.sabella@wvgazettemail.com, 304-348-5189 or follow @Gsabella on Twitter.

ACA outreach programs facing uncertainty, possible budget cuts http://www.wvgazettemail.com/article/20170913/GZ01/170919859 GZ01 http://www.wvgazettemail.com/article/20170913/GZ01/170919859 Wed, 13 Sep 2017 17:47:29 -0400 Jake Zuckerman By Jake Zuckerman The future is unclear for state Affordable Care Act advertising and outreach programs as they still have not received their federal grants for 2018 with two critical deadlines approaching.

Both the Healthy Start Navigator Project and West Virginia Navicare, which both assist people in enrolling in insurance through public exchanges under the ACA, also known as Obamacare, have not received their third year of grant funding, expected Sept. 1.

The organizations had funding slated for their third and final year, but received an Aug. 31 news release from the Centers for Medicare and Medicaid Services stating the agency plans to cut federal support for the Navigator program by 90 percent for the coming year from 2016 levels.

Additionally, the release states individual grantees under the program will now receive funding depending on how they met their enrollment quotas from the prior year.

For the month of September, West Virginia University has stepped up to provide stopgap funding for the Healthy Start Navigator Project through Sept. 30. West Virginia Navicare does not have interim funding. However, Jeremy Smith, its program director, said because Navicare operates under the umbrella operation of First Choice Services, which also offers gambling addiction and substance abuse hotlines, it should be able to keep its lights on until the funding issue is resolved.

Smith said Navigator programs help under-served populations work through the tricky, jargon-filled world of enrolling in a health insurance plan.

"We mainly focus on people that live in rural areas, have low literacy levels, have no internet availability, or other vulnerable populations that just may not be able to figure out their health insurance options themselves," he said.

Several important deadlines are creeping up for the ACA. For one, the open enrollment period for the exchanges begins Nov. 1 and closes Dec. 15. Smith said that window is half as long as it was last year.

Additionally, insurance providers have until Sept. 27 to decide if they want to participate in Obamacare exchanges for next year. Cuts to outreach could threaten projected demand, which could scare off insurers.

Smith said he estimates Navicare enrolled roughly 1,000 people last year in either the exchanges or Medicaid, and worked with a few thousand more.

According to an emailed statement from Healthy Start, its navigators have directly enrolled 500 West Virginians into health plans and offered one-on-one assistance to 2,000 more.

The funding cuts have raised concern President Donald Trump's administration is attempting to undermine or destabilize the markets for political reasons. In a Sept. 11 letter to Department of Health and Human Services Secretary Tom Price and CMMS Administrator Seema Verma, House Democrats requested information on the administration's plans to cut marketing and advertising for the open enrollment period by 90 percent.

"We are concerned that the Administration's decision to cut funding for the Navigator program is driven neither by concerns regarding the effectiveness of Navigators nor by a desire to safeguard taxpayer dollars," the letter states. "Rather, it appears that the decision fits within a pattern of Administration efforts to depress enrollment and sabotage the ACA."

That same day, an automated email from the program's grant administrators states final funding information will be available by the end of the week.

Instability under the law has been a mainstay of 2017. Though the House of Representatives voted to gut the law, the repeal effort came up one vote short in the U.S. Senate in July in a late-night showdown.

However, efforts are ongoing to repeal the law. Republican Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson, introduced a repeal-and-replace bill Wednesday similar to earlier efforts waged over the summer.

Across the aisle, Senator and former presidential candidate Bernie Sanders introduced a Medicare for all bill Wednesday as well.

For any bill to have a realistic chance of passing, the Senate would need to vote on it by Sept. 30, when it loses procedural protections under budget reconciliation rules, at which point it would need 60 votes to run.

Reach Jake Zuckerman at jake.zuckerman@wvgazettemail.com, 304-348-4814 or @jake_zuckerman on Twitter.

Future of Children's Health Insurance Program remains uncertain http://www.wvgazettemail.com/article/20170909/GZ01/170909614 GZ01 http://www.wvgazettemail.com/article/20170909/GZ01/170909614 Sat, 9 Sep 2017 14:46:36 -0400 Erin Beck By Erin Beck Janet Allio, school nurse at Mary C. Snow West Side Elementary, remembers wishing she could do more to help families who made too much for Medicaid, but couldn't afford private insurance, before the Children's Health Insurance Program began.

"They're able to have more preventative care, which means they lose less days of school and they're healthier overall," she said. "Healthy children are better learners."

CHIP, which covers children whose parents make too much for Medicaid but make less than 300 percent of the federal poverty level, celebrated its 20th anniversary last month. Federal funding for the program is set to expire on Sept. 30, the end of the federal fiscal year, unless Congress acts.

A spokeswoman for the state Department of Health and Human Resources said thousands of kids would lose their current coverage if the program isn't reauthorized.

All members of West Virginia's Congressional delegation said they are in favor of reauthorizing the program, except for Congressman Alex Mooney, a Republican, whose spokesman had no response.

Allio, who is also a member of the state CHIP board, has been a school nurse for more than 25 years.

"From a personal perspective, it gave me a feeling of helplessness because I wanted to do everything I could to help the child, yet the parent had no recourse, especially for children with chronic illnesses such as asthma or diabetes, where their health care could be quite costly," she said. "The child would be very ill and the parent would use the emergency room and hopefully be able to fall into the indigent program to receive care."

If CHIP isn't funded, children whose parents make more than 138 percent of the federal poverty level would have to turn to private plans for coverage.

"We even had parents that would give up their jobs and stop working so that their child would qualify for Medicaid," Allio remembered. "So when CHIP was born, it filled that gap."

CHIP was created by the Balanced Budget Act of 1997 and has been reauthorized for various lengths of time since then. Senator Jay Rockefeller, the former Democratic senator from West Virginia, was one of the leading proponents.

The U.S. Senate Committee on Finance held a hearing on CHIP funding Thursday. Sam Runyon, a spokesman for Democratic Senator Joe Manchin, said "We expect CHIP to move through in a bipartisan, non-controversial way" and that the senator supported the "vital program."

In July, the Medicaid and CHIP Payment and Access Commissiom (MACPAC) warned that "Congressional action to renew CHIP funding is urgent to ensure the stability of children's coverage during a time in which health insurance markets are expected to face substantial changes, and to provide budgetary certainty for states." MACPAC has also called for a five-year reauthorization. Lawmakers have disagreed on the length.

The last two times the program was reauthorized, Congress allocated funding for two-year periods.

CHIP covered around 31,000 West Virginia kids during the federal fiscal year 2016, according to DHHR. That includes kids going on and off the program. It covered 17,000 kids on CHIP-Medicaid during the same time period, meaning kids who were on Medicaid plans funded with CHIP money. Some children moved to CHIP-Medicaid Expansion when more people became eligible for Medicaid under the Affordable Care Act, also known as Obamacare.

During the April, May and June time period, CHIP covered about 21,000 kids, according to DHHR. That doesn't include CHIP-Medicaid.

Jessica Holstein, a spokeswoman for DHHR, said in an email that "more than 97 percent of West Virginia's children have healthcare coverage, partly due to the success of CHIP."

"However, this critical program is now facing uncertainty of federal funding post 2017," she said. "Should the CHIP federal funding issue remain unresolved on the national level, West Virginia CHIP funding will be exhausted in March or April 2018."

According to MACPAC, and an independent federal agency that advises Congress on Medicaid and CHIP policy, all states are expected to exhaust their CHIP funding by the end of 2017 or during fiscal year 2018 if funding is not extended.

"While we are hopeful that federal funding will be extended, further delays and the possibility of a curtailed CHIP match rate may put the program in jeopardy," Holstein continued. "The thousands of children who rely on WVCHIP may lose access to healthcare for a variety of reasons, including coverage availability and cost issues."

Sharon Carte, former director of CHIP in West Virginia, a member of the West Virginians for Affordable Healthcare Board, and a member of MACPAC, noted that parents would have no choice but to turn to private, more expensive plans with fewer benefits.

"They kind of fall off a cliff - a benefits cliff," she said.

The Affordable Care Act increased federal funding for the program. The law increased the federal match rate to 23 percent. That resulted in the program being 100 percent federally funded in West Virginia. The state is one of just 12 states that are 100 percent federally funded, according to the Kaiser Family Foundation.

"Not extending funding or changing the match rate lower than the current rate will force the state to find approximately $4 million in state dollars during a budget deficit year to continue funding children who moved from the separate CHIP to Medicaid as mandated by the ACA," Holstein said. "An additional $10 million is needed for the separate CHIP should the match rate be reduced - a total of $14 million in a budget deficit year. With no additional funding extended, the separate program would shut down."

In West Virginia, families who make over 211 percent of the federal poverty level pay a monthly premium of $35 for one child and $71 for two or more. Parents who make below that pay no monthly premium.

A family of four that makes from $36,900 a year to $73,8000 a year is eligible. Families with two children and the lowest incomes pay a maximum $300 co-pay for medical services and $200 for prescriptions per year. Families with the highest incomes and two children pay a medical maximum of $400 and a prescription maximum of $250.

Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.

County in OH to distribute 30,000 doses of overdose-reversing naloxone http://www.wvgazettemail.com/article/20170907/GZ0113/170909724 GZ0113 http://www.wvgazettemail.com/article/20170907/GZ0113/170909724 Thu, 7 Sep 2017 09:34:45 -0400 By Katie Zezima The Washington Post By By Katie Zezima The Washington Post Hamilton County, Ohio, will distribute 30,000 doses of an overdose-reversing drug to try to stop a rash of deaths that has besieged the area.

In what is believed to be the first program and clinical study of its kind in the country, the county will partner with hospitals, jails, faith-based groups and syringe exchanges that will distribute the medication, naloxone. The goal is to get it as close to people who are using drugs as possible to save their lives should they overdose.

Officials will gather and analyze data to answer this question: What would happen to the rate of opioid-related overdose deaths if a community were to be completely saturated with naloxone?

"The bottom line here," said Hamilton County Health Commissioner Tim Ingram, "is this is about saving people's lives and giving them a second and third chance at life and getting them into treatment so they can be treated for this disease of opioid addiction."

Hamilton County had at least 350 overdose deaths in 2015. First responders in the county carry naloxone and saved lives with it, but too many people were still dying.

Ingram and Shawn Ryan, the president and chief medical officer at BrightView Health, which runs treatment facilities in the area, wanted to do something. So they partnered with stakeholders across the county, including the county's five major health systems, the University of Cincinnati College of Medicine, and Interact for Health, a local nonprofit.

They also went right to the source of naloxone: Adapt Pharma, which manufactures the drug under the brand name Narcan. It donated 30,000 doses of the drug in a nasal spray form, which can easily be used on others.

"This is the first time anyone's approached us to say, 'Let's all get on the same page,' " said Mike Kelly, the president of Adapt. "We're going to blanket the community with Narcan nasal spray."

Now all of the groups will work together to distribute the drug and gather and analyze data to determine whether getting naloxone into the hands of tens of thousands of people will help decrease the number of overdose deaths.

Officials plan to distribute the drug in the next 45 days. The dissemination will be targeted at places in the county that have had some of the highest rates of overdose, based on data. Officials will collect data about every three months for about two years. The data will measure the number of doses distributed, the number used and the number of opioid overdoses that result in death or admission to an intensive care unit in Hamilton County.

Ingram said the plan is still a bit of a work in progress as it looks to collaborate with as many stakeholders as possible.

For example, Ingram said the coalition has been soliciting advice from people who are using drugs. The county sheriff's office suggested that they get extra doses of Narcan so they can distribute them to the spouse or partner of a person on whom they use Narcan when called to a drug overdose. It will be made available to people in the county jail whose charges or convictions involve opioids and are about to be released.

Hamilton County has been dealing with a rash of deaths from synthetic opiates, including fentanyl, a synthetic opioid 50 times more powerful than heroin, and carfentanil, which is used as a large animal tranquilizer and can kill people in minuscule amounts. The drugs are cut into heroin, and users often don't know what they are getting. Last year 174 overdoses were reported in Hamilton County, which includes Cincinnati, in less than a week.

Because the drugs on the street are now so powerful, a typical two milligram dose of naloxone wasn't reversing overdoses; authorities or doctors needed to use more than one. So the naloxone distributed as part of the program will be a higher dose: four milligrams.

Ingram said hospitals will provide Narcan to people who are treated for opioid overdoses and that the initiative plans to work with the county chamber of commerce to perhaps make some Narcan available to the business community. The goal, officials said, is to save people's lives and get them into treatment programs.

"In a perfect world maybe they can be the blueprint of what other communities need to do," Kelly said.

EPA rejected Dow Chemical's Institute cleanup plan http://www.wvgazettemail.com/article/20170906/GZ01/170909790 GZ01 http://www.wvgazettemail.com/article/20170906/GZ01/170909790 Wed, 6 Sep 2017 12:51:53 -0400 Ken Ward Jr. By Ken Ward Jr. Five months ago, federal regulators quietly rejected a Dow Chemical proposal for cleaning up toxic pollution at the Institute chemical complex, a move that court records show is now generating significant controversy in West Virginia State University's lawsuit against the chemical giant over contamination of the groundwater under the university's nearby campus.

Attorneys for State say that Dow misled a federal judge and the university with statements that suggested the U.S. Environmental Protection Agency had approved the company's cleanup plan, though EPA had specifically turned down the Dow proposal back in April.

Dow "withheld this fact from the court while claiming that EPA has "determined that any contamination beneath the WVSU campus ... can be effectively addressed without remediation" and that EPA is "presently in the middle of reviewing the corrective measures proposal that addresses proposed protective measures to be taken both at the Institute facility and the surrounding properties," the university's court filing said.

"But the truth is this: The EPA rejected Dow's proposed cleanup plan in April 2017," university lawyer Steve Ruby wrote in a court filing late last month.

Ruby cited an April 10 email that EPA sent to Dow and to the state Department of Environmental Protection.

Joan Schafer, a spokeswoman for EPA's regional office, confirmed federal officials had rejected Dow's proposal and said the EPA had asked for "additional information" that would "summarize their investigation in support of the proposed remedy." Schafer did not respond to requests for additional details or copies of any documents that outlined EPA's action.

In its own court filing, Dow sought to downplay the EPA action. Company lawyers said EPA's activities are "ongoing" and that "EPA has not yet approved the final version of the specific corrective measures proposal" for the site.

Word of EPA's move rejecting the Dow cleanup proposal emerged as the university and company are arguing over whether the lawsuit should be litigated in state or federal court, as Kanawha County officials press forward with their plans for a new youth sports complex at Shawnee Park near state's campus, and as the potential health threats related to one of the Dow chemicals -- 1,4-dioxane -- are getting increased attention nationally.

In late April, West Virginia State sued Dow and other former Institute plant owners and operators, seeking to force the companies to clean up contamination beneath the campus, prevent future migration of the chemicals, and compensate the university, a historically black institution, for harm to its image to the public and potential students. University officials and lawyers say three contaminants have been found at "elevated levels" in the groundwater 15 to 50 feet beneath the campus. The chemicals are 1,4-dioxane, 1,1-dichloroethane and chloroform.

University lawyers originally filed the case in state court. Dow moved it to federal court, and now State is trying to convince U.S. District Judge John T. Copenhaver Jr. to send it back to Kanawha Circuit Court.

Last year, the EPA said that 1,4-dioxane would be among the first chemicals that it would review under the provisions of the updated Toxic Substances Control Act, and on Wednesday the non-profit Environmental Working Group cautioned that the chemical has been found in tap water supplies that serve nearly 90 million Americans in 45 states. The report from EWG said that the chemical is classified as a likely carcinogen.

Because the university's tap water comes from West Virginia American Water's Elk River facility, the concern with the campus groundwater contamination is potential exposure to humans through vapors that could travel up through the soil. University officials have said that testing has found some chemicals above screening levels that would require more investigation, but has not discovered levels that create any immediate health threats to students, faculty, staff, or others on campus. University officials say they learned of the contamination about four years ago, when they took ownership from the state of the former West Virginia Rehabilitation Center, located between the campus and the chemical plant.

The plant in Institute has been operating since the late 1940s, and was for decades run by Union Carbide, a company that was once a major institution in the Kanawha Valley. The plant was sold to the French firm Rhone-Poulenc in 1986, and later to Bayer CropScience. It was sold to Dow, which has since merged with Carbide, in 2015. Chemical manufacturing facilities like the Institute plant are subject to the federal Resource Conservation and Recovery Act, or RCRA, which requires facilities to correct and clean up releases of hazardous wastes.

Dow had in January proposed a cleanup plan to EPA that would have -- without West Virginia State's approval -- prohibited any residential construction on parts of the rehab center property, and bar the use of the groundwater and impose "costly conditions" on any non-residential construction, the university says.

In an Aug. 21 court filing, Dow lawyers said that the case should remain before Copenhaver, in part because the university was in effect challenging a federally ordered cleanup of the site.

Dow lawyers said the EPA, after reviewing "voluminous scientific reports compiled over a period of years" had "determined that any contamination beneath the WVSU campus poses no threat to health or safety and can be effectively addressed without remediation." Dow noted that EPA had said in a July 2016 letter that the agency "agrees with the conclusions" presented by Dow in a report on the site. When they announced their lawsuit against Dow, West Virginia State officials had cited that same EPA letter as evidence in their effort to assure the campus community there was no current threat to the health of students, faculty or staff at the university.

University lawyers, though, learned more recently about the April 2017 email in which EPA rejected Dow's cleanup proposal.

"The EPA has approved no corrective measures for the groundwater contamination at issue here," the university's court filing said. "It has made no determination about what corrective measures are necessary. Indeed, the EPA does not even have a plan before it for approval. And even when a new plan eventually is submitted, it can only be approved after it is accepted by the EPA and undergoes public comment."

Reach Ken Ward Jr. at kward@wvgazettemail.com, 304-348-1702 or follow @kenwardjr on Twitter.

WV's new drug czar: 'We've got to get the death rate down' http://www.wvgazettemail.com/article/20170902/GZ01/170909923 GZ01 http://www.wvgazettemail.com/article/20170902/GZ01/170909923 Sat, 2 Sep 2017 14:49:21 -0400 Lori Kersey By Lori Kersey In his new role as director of the state Office of Drug Control Policy, one of Jim Johnson's first priorities is to stop the opioid epidemic's rising death toll in West Virginia.

"We've got to get the death rate down," Johnson said. The state's rate of overdose deaths - the highest in the nation - has a negative effect on its image and its economic development prospects, he said. "We've got to look at that and get the death rate down, and we can do that. We've done a good job with harm reduction and naloxone. There's a lot of room to improve what do we do after [overdose patients are] revived with naloxone."

Johnson, 66, spent 29 years as a Huntington police officer and went on to serve as police chief. He has also served as the director of the Huntington Mayor's Office of Drug Control Policy since its inception in 2014. It's believed to have been the first of its kind for a West Virginia city.

"I don't know of any cities our size that had one," he said. "Maybe some of the major cities. But our problem is unique here in Appalachia. We knew we had to look at some different [approaches] because of what we we're facing."

Johnson said the Huntington office tried to take a holistic approach to addressing the opioid epidemic.

That meant helping form partnerships between all sorts of organizations in the city, from the city's religious community, to the medical field, its schools and nonprofit organizations.

They realized that the solution couldn't be just law enforcement. It would take treatment and prevention, too, Johnson said.

Part of that realization came during a 2014 push to arrest drug dealers in the Huntington area while he was serving as chief. "Operation River to Jail" saw more than 200 arrests in 90 days, but Johnson said the arrests were just moving the problem, not solving it.

"As long as we had the demand we had, there was going to be a supply," Johnson said.

In his law enforcement career that started in 1972, he's never seen anything like the opioid epidemic, he said. It affects not only the frequent troublemakers but an 18-year-old with a toothache, young mothers, a miner with a back injury, he said.

Johnson officially starts his job as state drug czar Tuesday. He said one of the first things he wants to do is get out to different communities and see what they're doing and what the state can do to help.

"The answers are going to be in communities," Johnson said. "The closer you are to the problem, the more you're going to know about it and that's where the answers are going to be."

To help drive down the opioid overdose death rate, Johnson said more should be done to get overdose patients into treatment after they've been revived with naloxone.

After more than two dozen people in five hours overdosed in Cabell County last year, a follow-up study from the state indicated that none of the patients got into treatment for their drug addictions.

Johnson said quick-response teams, like those that have been in place in Huntington on a trial basis, will be a key component of getting people who overdose into treatment. A coalition in Huntington is hoping to get grant funding to expand the program, but they've seen success with its trial implementation, he said.

While Johnson is the director of the office, Dr. Rahul Gupta, the state health officer, and Dr. Bill Crouch, the cabinet secretary of the state Department of Health and Human Resources, are overseeing it.

Johnson said the only way the state will combat the problem is if law enforcement and the medical community work together.

"That's the only way we're gonna be able to tackle it," Johnson said. "We've got a public health problem. I can't tell you how the brain is changing [on opioids]. In law enforcement, we have to have the resources to cut the supply, but one way we know to cut the supply is to cut the demand down."

Gupta said one of the goals of the new drug control policy office, as mandated by law, is to create a strategic plan by July to reduce the prevalence of opioid, alcohol use and smoking by 10 percent. The office will also aim to work across all sections of West Virginia to maximize efforts and resources to communities and to develop data collection methods that will help the state and local communities make decisions.

Close to 900 people in West Virginia died of drug overdoses last year, Gupta said.

"We are working right now to learn from those deaths," he said.

Other priorities will be to work with the school system to get prevention education in the K-12 classrooms and to get naloxone training for teachers. Gupta also wants to increase the opportunities that women of childbearing years have to get long-acting reversible contraceptives in an effort to reduce the number of babies who are born to drug-dependent mothers.

Gupta said one of the main reasons that Johnson was chosen for the job was because he understands that opioids are a public health problem that touches every aspect of a community.

"He's the best. We're so thrilled to have him," Gupta said.

Reach Lori Kersey at lori.kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.

WVU Medicine sending providers to The Greenbrier Clinic http://www.wvgazettemail.com/article/20170901/GZ0115/170909952 GZ0115 http://www.wvgazettemail.com/article/20170901/GZ0115/170909952 Fri, 1 Sep 2017 17:40:01 -0400 Staff reports By Staff reports WVU Medicine is now sending providers to The Greenbrier Clinic, according to a news release sent Friday.

New services, including neurology, rheumatology, hematology/oncology and expanded gastroenterology will be offered "on a periodic basis" to the "executive" patients at The Greenbrier Clinic, the release states.

Angela Jones-Knopf, a spokeswoman for WVU Medicine, said that while the clinic has referred patients to WVU in the past, "the difference is that we'll have specialists on site and they are adopting our medical records system."

The Greenbrier Clinic will convert its information system to the EPIC system used by WVU Medicine, "allowing for a more seamless flow of communication." the release states.

WVU Medicine became the official sports medicine provider for The Greenbrier earlier this year, providing training services for events such as the Houston Texans Training Camp, The Greenbrier Classic and The Greenbrier Champions Tennis Classic.

According to the release, The Greenbrier Clinic is located "in the West Virginia wing of The Greenbrier," which is owned by Governor Jim Justice and located in White Sulphur Springs. The clinic "sees thousands of patients each year who come to combine a relaxing, luxurious holiday" with treatment, the release says.

New Cross Lanes cannabidiol company seeing high demand http://www.wvgazettemail.com/article/20170901/GZ0115/170909969 GZ0115 http://www.wvgazettemail.com/article/20170901/GZ0115/170909969 Fri, 1 Sep 2017 14:41:02 -0400 Erin Beck By Erin Beck No one was wearing tie-dye.

During a two-hour span one afternoon this week, it was a rare moment when no customers were inside of Appalachian Cannabis Company, a less than two-week-old business in Cross Lanes.

A 64-year-old man from an adjoining state drove an hour and half in the hopes that a product made with cannabidiol, referred to as CBD, would help his wife with her arthritis.

A woman with silver hair asked Scott McKenzie, an employee, if the product will make her high. He assures her that it won't.

Tetrahydrocannabinol, known as THC, is the compound in marijuana that causes a high.

CBD, another component, "may relieve pain, lower inflammation and decrease anxiety," according to the National Institutes of Health, although the products have not been approved by the FDA for medical use.

CBD "appears to be a safe drug with no addictive effects," according to the National Institute on Drug Abuse.

Appalachian Cannabis Company opened on Aug. 19 at 130 Goff Mountain Road, in Cross Lanes. They received 1,000 Facebook messages in the first day, owner Chris Yeager said.

To answer some of the questions, he decided to host a Q&A on Facebook Live. He ended up talking for an hour.

"We are finding that people are getting their lives back," he said. "And it's giving them their liberty."

R.D. Brunty, a truck driver from Teays Valley, already was a repeat customer by Thursday. He has anxiety and COPD. The anxiety will keep him in bed for days at a time.

"I actually got out of bed to come here when I read this was open," he said. "Within four to five days of taking it, my anxiety level tremendously dropped."

It used to take him an hour and a half to mow his lawn - a task that he said takes a younger man about 40 minutes to complete. When he does it, he normally has to rest and catch his breath about three times.

"Today I cut the grass the first time without ever having to stop," he said.

He wasn't sure about giving his name. He didn't want his mom to read about it in the paper.

Then he listened to Yeager talk about why he opened the business.

Yeager used to work in media and marketing. Then about seven years ago, his uncle and brother died of opiate-related deaths. Both used Suboxone, and had traces of opiates in their system when they died.

"My brother was on Christmas Eve," he said.

He decided to follow medical marijuana to Colorado, and immerse himself in the industry - "instead of relying on a pharmaceutical company to come in and heal us," he said.

He's wearing a shirt with the slogan "Pot Over Painkillers."

"I know more young people that have died from opiates than I do grandparents and old people that have died from natural causes," he said.

A Marine Corps veteran, he also lobbied at the West Virginia Legislature for years.

"I would tell them I am basically a criminal right now because I am using cannabis for my PTSD," he said.

Brunty listened to the story and decided to give his name after all, even if it means his mom finds out.

"She watched me cut the grass for the first time," he said. "Now I'm going to talk to her and say this is why."

"The community that comes around cannabis is part of the therapy," McKenzie explains.

He had worked in the industry in California, before moving back to Kentucky.

"I was planning on leaving again," he said, until he saw an advertisement for a job at the cannabis company.

"I left my job that morning," he said.

In the past 10 days, he's met people who have driven hours.

"A lot of people are coming here as a last resort," he said. "It's heartbreaking."

The store sells topicals, tinctures, gummies, capsules, syrups, vapeable products and concentrates. Prices vary. Some of the tinctures are hundreds of dollars. Ten 25-milligram gummies are $45. Ten 10-milligram capsules are $25.

"These stores are popping up all over the country, and the legality of their products is a subject of considerable debate," said Matt Simon, a West Virginia native who works for the Marijuana Policy Project. "It is hard to find clarity on this issue given the murkiness of federal laws and policies."

Asked about the DEA's prohibition on marijuana, Yeager cited the 2014 farm bill - the Agricultural Act of 2014 which "(a)uthorizes an institution of higher education or a state department of agriculture to cultivate industrial hemp if: cultivated for purposes of research under an agricultural pilot program or other agricultural or academic research, and allowed under the laws of the state in which the institution or department is located and the research occurs."

West Virginia code allows a person growing hemp for industrial purposes to apply for a license from the agricultural commissioner.

Appalachian Cannabis Company has a "Research and Marketing Cultivation of Hemp License" from the West Virginia Department of Agriculture displayed on the wall.

It also has a West Virginia flag displayed on the wall, but that's about it. They don't get their phone number assigned until Friday.

"I'll be honest with you," Yeager said. "I didn't expect it to take off like this."

In an August call for comment on CBD and several other drugs, the FDA said: "CBD has been shown to be beneficial in experimental models of several neurological disorders, including those of seizure and epilepsy. In the United States, CBD-containing products are in human clinical testing in three therapeutic areas, but no such products are approved by FDA for marketing for medical purposes in the United States."

"We're not allowed to call it a medicine," Yeager said. "We're not allowed to make claims that it heals anything... It helps with this and it helps with that."

Product testing, he said, is done in house. He said they test for contaminants, pesticides, and microbial content.

Yeager says that the business currently is focused on CBD, but has not ruled out the possibility of selling medicinal marijuana in the future.

But when the medical marijuana bill and a bill expanding the number of people who could sell CBD in West Virginia passed last legislative session, it "really ignited a fire in us to get going quickly," he said.

Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.

Opioid-addicted zebrafish could be key to finding new human treatment http://www.wvgazettemail.com/article/20170901/GZ0116/170909973 GZ0116 http://www.wvgazettemail.com/article/20170901/GZ0116/170909973 Fri, 1 Sep 2017 08:47:57 -0400 By Travis M. Andrews The Washington Post By By Travis M. Andrews The Washington Post As the opioid epidemic sweeps through America, scientists are scrambling to understand its addictive power in hopes of developing new treatment methods.

In the process, they discovered that zebrafish can become opioid addicts. Researchers at the University of Utah hope their study of the addicted fish could be helpful in creating new treatments for humans.

They outlined their findings in a paper recently published in the journal Behavioral Brain Research.

The goal of the research is to find a new method of treating opioid addiction that doesn't require other opioids. At present, treatment involves substituting one drug, such as heroin, with another, such as methadone, in hopes that addicts' usage will eventually taper off.

"There is still a compelling need for therapies that work in different ways, not just by replacing one opioid with another," Randall Peterson, dean of the College of Pharmacy at the University of Utah, told National Geographic.

Zebrafish are a freshwater tropical fish that grow to about 2½ inches in length and have a black and white pattern, much like zebras. Researchers observed their addictive behavior in an environment where the fish could self-administer opioids.

First, they set up a fish tank containing two platforms on opposite sides, one white and one yellow. The yellow platform contained a sensor. When the fish swam over the sensor, it released food while a green light flashed. Nothing happened when they swam over the white platform.

Then, once the zebrafish learned how the sensor worked, researchers replaced the food with hydrocodone, an opioid commonly known as Vicodin. With each pass, the drug was released into the water and ingested by the fish. The water was continuously flushed out of the tank and replenished, so the fish had to repeatedly trigger the sensor to receive more of the drug.

The fish quickly reacted to the drug, flocking to the yellow opioid-dispensing platform at an astounding rate. They were placed in the tank for 50 minutes each day for five days. During each session, some of the fish visited the opioid platform nearly 2,000 times.

When the drug was removed, they visited it about 200 times on average and showed signs of agitation and anxiety, the study said. And when the researchers raised the opioid platform so the water over it was shallow - a condition zebrafish naturally go to lengths to avoid - the fish continuously swam up to the platform for more hydrocodone.

"What's new here is that this is a self-administration model where the fish have to perform an action to receive a drug, so that's fundamentally different in terms of the way the brain responds to the drug," Peterson told National Geographic. "[This enables] us to measure motivation in drug-seeking in a more complete way."

The study is important, because not only do zebrafish share 70 percent of the same genes with humans, as Futurism reported, they also share a similar neurological makeup - an μ-opioid receptor and two neurotransmitters - to humans, meaning they react to addiction in the same way.

"Drugs of abuse target the pathways of the pleasure centers very effectively," Gabriel Bossé, an author on the study, told Medical Xpress. "These pathways are conserved in zebrafish, and the fish can experience some of the same signs of addiction and withdrawal as people."

An estimated 2.6 million people in the United States are addicted to opioids, as The Post noted. In 2015 alone, more than 33,000 Americans died by overdosing on various opioids, be they prescription pain relievers or heroin, according to the American Society of Addition Medicine.

President Donald Trump declared the opioid crisis a national emergency in early August.

"The opioid crisis is an emergency, and I'm saying officially right now it is an emergency," he said. "It's a national emergency. We're going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis."

Bringing new treatment methods to market is a slow process. Zebrafish could prove advantageous as test subjects and help accelerate the process because they are prolific breeders, the Utah researchers said. One female fish can produce 200 eggs each day, according to the Verge.

Not only could researchers study addiction on thousands of fish, they could also trace potential genetic mutations stemming from addiction, the researchers said.

Groups ask FDA to ban high-dose opioid painkillers, citing overdose danger http://www.wvgazettemail.com/article/20170831/GZ0115/170839926 GZ0115 http://www.wvgazettemail.com/article/20170831/GZ0115/170839926 Thu, 31 Aug 2017 16:41:23 -0400 By Carla K. Johnson The Associated Press By By Carla K. Johnson The Associated Press CHICAGO (AP) - Safety advocates and state health officials are formally calling on the Food and Drug Administration to ban high-dose opioid painkillers to prevent accidental overdose deaths among patients and people who abuse drugs.

A petition filed Thursday asks the FDA to ban opioid pills that, when taken as directed, would add up to a daily dose of more than 90 milligrams of morphine. The Centers for Disease Control and Prevention has said that level is dangerous for most patients and doesn't improve pain control or the ability to function.

The petitioners claim toddlers and preschoolers who get their hands on the pills and teenagers who experiment with drugs would be less likely to overdose and die if the high-dose pills were off the market.

The petition was signed by leaders of the Association of State and Territorial Health Officials, Physicians for Responsible Opioid Prescribing, the National Safety Council and the American College of Medical Toxicology.

"The existence of these products implies that they're safe. They're not," said Dr. Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and an outspoken advocate for opioid reform.

While the petition seeks a ban on many high-dose opioid tablets and under-the-tongue films, it singles out the OxyContin 80 milligram tablet, which is taken twice daily, adding up to 240 morphine-equivalent milligrams.

OxyContin maker Purdue Pharma spokesman Robert Josephson in an email that the "petition and issue should be discussed by the scientific experts at FDA and we look forward to participating in such a discussion," adding that it's important to seek "the appropriate balance" of treating severe pain while combating the opioid crisis.

FDA officials declined to comment on the petition but FDA Commissioner Dr. Scott Gottlieb has called the opioid epidemic his "highest immediate priority" and has been willing to consider abuse of opioids in evaluating their safety. In July, the painkiller Opana ER was pulled from the market at the FDA's request following a 2015 outbreak of HIV and hepatitis C in southern Indiana linked to sharing needles to inject the pills.

More than 15,000 people died from overdoses involving prescription opioids in 2015.

Kolodny said patients won't be harmed by banning the high-potency drugs because they can swallow two pills instead of one.

University of Alabama addiction researcher Dr. Stefan Kertesz disagreed.

"With a very large number of pills to manage, they are going to be at more risk of taking the wrong number of pills and of having some of those pills swiped by others without them noticing," Kertesz said.

The CDC guidelines, Kertesz said, urge cautious prescribing at higher doses.

American Academy of Pain Medicine President Dr. Steven Stanos said a ban combined with insurance restrictions could lead to under-treatment of pain for a small number of patients. The group plans to file a formal response to the FDA, he said.

Any U.S. citizen can file a petition with the FDA to ban a drug or medical device for safety issues. The FDA is expected to respond within six months.

Obamacare's Medicaid expansion fueling opioid epidemic? Probably not http://www.wvgazettemail.com/article/20170831/GZ0115/170839928 GZ0115 http://www.wvgazettemail.com/article/20170831/GZ0115/170839928 Thu, 31 Aug 2017 16:33:45 -0400 By Carla K. Johnson and Ricardo Alonso-Zaldivar The Associated Press By By Carla K. Johnson and Ricardo Alonso-Zaldivar The Associated Press WASHINGTON (AP) - An intriguing new theory is gaining traction among conservative foes of the Obama-era health law: Its Medicaid expansion to low-income adults may be fueling the opioid epidemic.

If true, that would represent a shocking outcome for the Affordable Care Act. But there's no evidence to suggest that's happening, say university researchers who study the drug problem and are puzzled by such claims. Some even say Medicaid may be helping mitigate the consequences of the epidemic.

Circulating in conservative media, the Medicaid theory is bolstered by a private analysis produced by the Health and Human Services Department for Sen. Ron Johnson, R-Wis. The analysis says the overdose death rate rose nearly twice as much in states that expanded Medicaid compared with states that didn't.

Independent experts say the analysis misses some crucial facts and skips standard steps that researchers use to rule out coincidences.

Johnson has asked the agency's internal watchdog to investigate, suggesting that unscrupulous individuals may be using their new Medicaid cards to obtain large quantities of prescription painkillers and diverting the pills to street sales for profit. Diversion of pharmacy drugs has been a long-standing concern of law enforcement.

"These data appear to point to a larger problem," Johnson wrote. "Medicaid expansion may be fueling the opioid epidemic in communities across the country." He stopped just short of fingering Medicaid, saying more research is needed.

But if anything, university researchers say Medicaid seems to be doing the opposite of what conservatives allege.

"Medicaid is doing its job" by increasing treatment for opioid addiction, said Temple University economist Catherine Maclean, who recently published a paper on Medicaid expansion and drug treatment. "As more time passes, we may see a decline in overdoses in expansion states relative to nonexpansion states."

Johnson is a conservative opponent of "Obamacare" who backed GOP efforts to curtail the Medicaid expansion. Wisconsin officials have urged him to push for changes in the health law to ensure the state wouldn't be penalized for rejecting federal dollars to expand Medicaid.

Trump administration officials, including Health Secretary Tom Price and Seema Verma, head of the Centers for Medicare and Medicaid Services, have strongly criticized Medicaid, saying the program doesn't deliver acceptable results.

Price's agency would not answer questions about the analysis for Johnson, and released a statement instead.

"Correlation does not necessarily prove causation, and additional research is required before any conclusions can be made," the statement said.

Translation: Just because something happens around the same time as something else, you can't assume cause and effect. The statement said the administration is committed to fighting the opioid crisis.

Medicaid is a federal-state program that covers more than 70 million low-income people, from newborns to elderly nursing home residents and the disabled. Thirty-one states have expanded Medicaid to serve able-bodied adults, while 19 have not. The expansion went into effect in January, 2014, and the most recent national overdose death numbers are for 2015.

That leaves researchers with just a small slice of data. Both sides agree more research is needed.

Still, some patterns are emerging.

Prescriptions for medications used to treat opioid addiction in outpatient settings increased by 43 percent in Medicaid expansion states compared with states that didn't expand, according to Maclean's research with Brendan Saloner of Johns Hopkins Bloomberg School of Public Health. That indicates Medicaid is paying for treatment.

Maclean and Saloner also found another piece of the puzzle: Overdose death rates were higher to begin with in states that expanded Medicaid.

That's important because it suggests that drug problems may have contributed to state decisions to expand Medicaid. States such as Ohio with high overdose rates might have wanted to leverage more federal money to help fight addiction

Maclean and Saloner looked at deaths from overdoses and fatal alcohol poisoning from 2010-2015, starting well before the Medicaid expansion. The HHS analysis for Sen. Johnson missed that underlying trend because it started with 2013 data.

When Gov. John Kasich, R-Ohio, talks about why he expanded Medicaid, "it has a lot to do with mental health and substance use disorders," said Republican labor economist Craig Garthwaite of Northwestern University's Kellogg School of Management.

Garthwaite finds the claim that Medicaid expansion fueled drug deaths "fundamentally flawed."

Still another problem with the Medicaid theory is that it lumps all drug overdoses together. But illicit drugs - heroin and fentanyl - have been driving surges in deaths since 2010. A Medicaid card doesn't provide access to illegal drugs.

"It's worrisome because this is the type of numerical evidence that's used to propose bad policy," Garthwaite said.

Maclean, who reviewed the HHS analysis, said it seemed to rely on raw numbers without controlling for a range of differences among states, a standard technique.

Some researchers see hints that Medicaid expansion may be helping to mitigate the overdose epidemic.

Vanderbilt University economist Andrew Goodman-Bacon and Harvard's Emma Sandoe drilled down to the county level in an informal analysis. From 2010 through 2015, counties with the largest insurance coverage gains experienced smaller increases in drug-related deaths than counties with smaller coverage gains.

More research is needed to provide conclusive evidence.

Relying on faulty research is "dangerous," said Maclean. "It can lead to bad policies and people's lives are at stake here."


Johnson reported from Chicago.

Report: WV adult obesity rate highest in US http://www.wvgazettemail.com/article/20170831/GZ0115/170839935 GZ0115 http://www.wvgazettemail.com/article/20170831/GZ0115/170839935 Thu, 31 Aug 2017 11:38:45 -0400 The Associated Press By The Associated Press While a third of American adults and one in six children are obese, a report Thursday suggests the rate of increase could be stabilizing in some states.

Citing statistics collected by the U.S. Centers for Disease Control and Prevention, the report by the Trust for America's Health and the Robert Wood Johnson Foundation said West Virginia had the highest obesity rate at 37.7 percent. Mississippi was second at 37.3 percent and Alabama and Arkansas were tied for third at 35.7 percent.

The report says the adult obesity rate increased between 2015 and 2016 in Colorado, Minnesota, Washington and West Virginia, fell in Kansas, and was stable elsewhere. Colorado had the lowest rate, at 22.3 percent.

This is the first time in 14 years of conducting the annual report that any state's rate dropped, and rates of increases in other states have begun to slow, Trust for America's Health President and CEO John Auerbach said.

The report recommends focusing on early childhood prevention efforts, including promoting exercise, expanding investments in community-based programs, increasing health-care coverage for obesity prevention and treatment, and improving school-based efforts to provide healthy meals and physical activities.

"We conclude the report with a fair amount of optimism," Auerbach said on a conference call. "The adult rates are showing signs of leveling off and the childhood rates are stabilizing. In our review of the policies and strategies, we found that many [states] show a lot of promise for reversing the trends and improving health if we make them a higher priority."

The study analyzed CDC data on body mass index, a measure of height and weight. People with a BMI of 25 to 29 are considered overweight; 30 and above is obese.

The report noted that 25 states had obesity rates above 30 percent. In 2000, no state had a rate above 25 percent.

Nine of the 11 states with the highest obesity rates are in the South. States in the Northeast and the West had lower obesity rates.

Auerbach said obesity costs the nation more than $150 billion in preventable health care costs and contributes to many different health problems.

Those problems are particularly acute in the 13-state Appalachian region, which lags behind the rest of the country in 33 of 41 public health indicators, including seven leading causes of death, according to a separate study released last week by the Robert Wood Johnson Foundation, the Appalachian Regional Commission and the Foundation for a Healthy Kentucky.

Obesity rates were higher among adults without a college education or with annual incomes below $15,000.

The report also found one in four young adults who tried to join the military were deemed ineligible due to fitness and weight concerns.

"Obesity rates are still far too high, but the progress we've seen in recent years is real and it's encouraging," said Dr. Richard E. Besser, the Robert Wood Johnson Foundation's president and CEO. "That progress could be easily undermined if leaders and policymakers at all levels don't continue to prioritize efforts that help all Americans lead healthier lives."

Kanawha commission holding public hearing about Shawnee test results http://www.wvgazettemail.com/article/20170830/GZ01/170839967 GZ01 http://www.wvgazettemail.com/article/20170830/GZ01/170839967 Wed, 30 Aug 2017 17:44:03 -0400 Staff reports By Staff reports Anyone with concerns or questions about the chemicals found at the site of a proposed multi-sport complex in Institute will have an opportunity next week to ask questions.

The Kanawha County Commission has scheduled a public hearing for 8 a.m. Tuesday to discuss the results of groundwater, air, soil gas and soil vapor testing done at Shawnee Park, where the commission plans to build a youth sports complex.

Ashok Sanghavi of S&S Engineers, a firm the commission hired to review the results of the testing, will be at the meeting, according to the agenda.

The commission on Tuesday released the results of the latest round of chemical testing at the park.

Those results indicate that chloroform concentrations decrease radially in all directions from the maximum detected location in the soil vapor, or the vapor in the air spaces between soil particles. The chemical was not detected in an ambient air sample at the park.

Commissioner Ben Salango said the results indicate the chloroform came from the golf course or some other localized source and not the nearby chemical plant owned by Dow Chemical.

An initial report, released earlier this summer from CH2M Hill, said that 1,2-DCA, 1,4-dioxane and naphthalene were found in the shallow groundwater of the park and 1,4-dioxane was found in the deep groundwater at concentrations greater than screening criteria.

Dow agreed to fund the chemical tests at the park after nearby West Virginia State University sued the company and previous owners of the plant alleging that decades of chemical manufacturing at the Institute plant contaminated the groundwater beneath its campus. The lawsuit insists the contamination poses no health risks because the campus does not use groundwater for its drinking water. It says the pollution threatens campus development plans and the school's reputation.

Also Tuesday, the commission will discuss repaying early the remaining $1.8 million it owes on the construction of a new bridge at Coonskin Park, Commission President Kent Carper said. With the state's approval, the county would make a one-time payment of $1.5 million, saving $300,000. The Central West Virginia Convention and Visitors Bureau, which had been making payments on the bridge, will continue to make those payments, but the money will go toward paying down the debt on the sports complex, Carper said.

Also on Tuesday's agenda is a public hearing on the commission's vote to raise the excise tax on property transfers.

The commission meets at the Kanawha County Commission Courtroom at the Kanawha County Courthouse.

Mindfulness training to help first responders deal with opioid crisis http://www.wvgazettemail.com/article/20170827/GZ0118/170829654 GZ0118 http://www.wvgazettemail.com/article/20170827/GZ0118/170829654 Sun, 27 Aug 2017 20:48:17 -0400 Erin Beck By Erin Beck Capt. Mark Strickland, EMS supervisor for the Charleston Fire Department, said he sleeps on his left side. Another firefighter and medic, Capt. Craig Matthews, said he normally faces north when he sleeps.

At least, those are the smart-aleck answers they give when asked how they sleep at night.

Steven Hicks, another Charleston firefighter, will tell you though, about how often he wakes up.

Hicks recently responded to the overdose death of a pregnant woman. She was six months along.

"That really messed with me," he said. "I just had a baby. I didn't understand how somebody could do that."

"I'll get up sometimes and check on my kid. ... Ever since that baby died, I get up more often now," he said.

Hicks has been on the job less than two years. Overdoses, by now, are "pretty much second nature."

"We don't even talk about it anymore," Matthews said. "Twenty years ago, if we had to give Narcan, we'd talk about it for a week."

"There's no ending to the story," he said. "You never see anyone get better."

Hicks and a more senior firefighter, Lt. Jason Whiting, recently sat in a common area at the Morris Street fire station, talking about being fathers and how a child "should not know what heroin or an overdose is."

"It's a pebble in a pond," Whiting said. "That ripple goes and goes, and that child will live with that."

They all have different coping mechanisms.

"I pray about it," Hicks said. "I'm a Christian. I believe that praying releases stress."

For Whiting, it's three things: "Fishing, family and, most importantly for me, faith."

They rely on each other for support. They may talk about the cases that bother them over a pot of coffee. They use gallows humor. They mock each other.

"Because we've all been down that road," Whiting said.

They're less likely to open up to outsiders.


Richard Goerling, a police lieutenant in Oregon, developed a training on first responder resiliency and performance. He'll bring that training to West Virginia in late fall by teaching mindfulness to first responders - including police, fire and EMS - from Cabell, Kanawha and Putnam Counties."We see so much human suffering that doesn't make sense, and we try to make sense of it," Goerling said. "Our sense-making creates stress."

Dr. Michael Brumage, executive director and health officer for the Kanawha-Charleston Health Department, and Brittany Canady, a health psychologist at Marshall University, applied for the $49,000 grant to get the training. They said they hope to bring what they learn to other agencies across the state.

Goerling is also a co-investigator in National Institutes of Health mindfulness research and its impact on police officers, and he holds an affiliate assistant professor appointment at Pacific University in the Graduate School of Psychology.

He will hold trainings for 35 people each time. Organizers will recruit participants, primarily from Kanawha and Cabell counties. They haven't announced a location.

Goerling has held similar, eight-week trainings out of state, but this one will be an immersion training, meaning responders will be focused on it for two-and-a-half days straight.

"This is not about talking at people, but having them experience what this is like through practice," Brumage said.

More information on the training is available at www.mindfulbadge.com/training.

First responders don't have to attend if they don't want to. And many are already showing resistance - some oppose it and don't think the training is needed. Some think it's outright comical to even suggest it's needed.

"Ignoring emotion actually makes us more weak," Goerling said. "Typically today we wait until first responders are broken, and then we try to fix them."

Goerling said he started working in the field 14 years ago because he was worried about excessive use of force among police officers.

"It's really not about trying to help first responders feel better," he said. "On some level, I don't give a s--- how we feel. I give a s--- about how we perform."

It's unclear whether the training could reduce preventable injuries, such as unwarranted use of force or distracted-driving crashes.

"I think we can speculate that, yes, it does," Goerling said. "Do we have data that suggests that it will? Not yet."

But research suggests it improves sleep, he said, and reduced fatigue, in turn, reduces cognitive errors.

West Virginia Clinical and Translational Science Institute will conduct research on the training based on standardized self-assessments and stress hormones in a person's saliva before and after, Brumage said.

The idea came from meetings of the Great Rivers Harm Reduction Coalition, a group of public health professionals, first responders and academics from Kanawha, Cabell and Putnam counties. Burn-out and compassion fatigue - common among people whose work frequently exposes them to trauma - often came up.

"When repeatedly exposed to people who are overdosing, especially those who have repeated overdoses, we're facing cynicism, and some of the older law enforcement officers expressed a kind of detachment from both work and personal lives," Brumage said. "They just became so cynical over time. They weren't as effective as they could have been - either professionally or personally."

Brumage has worked on similar programs with the military and with some members of the West Virginia University football team.

"If you're facing a life-and-death event, you need to be fully present for that event to be most effective," he said. "If you are either burned out, and therefore dull in your response, or you're hypervigilant, then you're not operating in your optimal zone.

"Emotions are going to arise whether you like them to or not, as well as distractions. The key is to recognize them and to let them pass to be able to focus on the task at hand and then later to be able to have a healthy way to deal with those things."


Mark Strickland, EMS supervisor for Charleston Fire Department, responds to high-priority incidents. He works 24 hours at a time, then he takes the next 48 hours off. He gets sleep when he can. Strickland is an advocate for the training.

"Meditation has never been one of those things we've sold to the fire department," he said. "The fire service also didn't use to run ambulance calls, so things change."

He admitted, "It's a tough sell."

But Strickland said he takes every training he can because he wants to be prepared for any situation. He started as a part-time EMT in 1994, the year he graduated high school, but he has been in his current position for about 12 years.

His first heroin overdose patient was in 2001, on Seventh Avenue.

Someone told him to remember, "This is what a heroin overdose looks like. Now remember this, because you won't see one of these for a long time."

The next time, it was a Vietnam veteran. Soon, using Narcan became just another part of the job.

First responders revive someone, and the next thing they know, they're in a fight because the patient thinks they're cops, he said. The anger builds up.

"You could have been dead, and you just cussed me," Strickland said. "I don't want people taking that anger to the next call."

Strickland has three kids at home, and he tries to teach them drugs are bad.

"Then I dress up in navy blue and go to work, and I'm supposed to hug you and tell you it's OK you have an addiction problem," he said.

Hodges, the director of EMS operations, said he, too, struggles with the repeat patients.

"They cheated death, and they walk away," he said. "Years ago, we would take care of a sick person, and they were appreciative of it."

"The next call, the middle-aged man that has a heart attack - his family loses him," he said.

Hodges began his EMS career in Whitesville in 1998. He became a firefighter and paramedic in 2004. The first overdose he ever responded to was in Kanawha City.

"I'm from a remote area of Boone County," he said. "I was like, oh my god, there's heroin. That's the worst. This person's really bad off. We need to get them some help."

Now, he said, "I'm not going to focus on this one guy, when there's 100 more out here in the city that are addicted."

Lt. Ryan Pennington was one of the firefighters who gave an honest answer to that question: "How do you sleep?"

"I don't sleep, ever," he said. His rhythms are off, from chasing overdoses all night.

He said his support system helps him. But as for the training, he said, "Well I hope these young guys will go do it."

"I think the older guys have learned how to compartmentalize it more," he said.

But in his early days with the fire service, they used to spend more time at each other's houses. They don't do that as much, now.

"All of a sudden," he said, "you're yelling at your wife that you saw a dead baby that day."

Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.

Concert encourages collaboration for a good cause http://www.wvgazettemail.com/article/20170826/GZ01/170829683 GZ01 http://www.wvgazettemail.com/article/20170826/GZ01/170829683 Sat, 26 Aug 2017 18:53:31 -0400 Max Garland By Max Garland The West Virginia Symphony Orchestra, amateur musicians and West Virginia State University students and faculty held a benefit concert Saturday afternoon to support programs supporting children born to drug-dependent mothers. The Orchestra of the Hills and Chorus returned for its second year, performing at Christ Church United Church to benefit the Charleston Area Medical Center Foundation.

Support for the June 2016 flood victims was the focus of the inaugural concert, but concert donations this year will go toward assistance for infants born to mothers who are addicted to drugs.

"It's unfortunately hugely prominent in West Virginia," said Dr. Scott Woodard, the director of the concert. "West Virginia has 10-times the national average of babies being born drug-dependent here because of mothers with drug addiction or abuse during pregnancy."

One of the most interesting aspects of the concert is having professionals collaborate with students and amateurs, Woodard said, providing valuable teaching moments for the less experienced. Roughly 140 musicians participated in total, he said.

Encouraging collaboration for a good cause is a vital part of the concert, said Joe Tackett, president of the West Virginia Symphony Orchestra.

"I get tired of having silos set up with people saying, 'these are professionals and these are amateurs,'" he said. "As a community we want to come together and address issues, so why not get together and take part through music?"

Some of the concert's pieces were appropriately somber considering the subject matter, but Woodard said they wanted to make sure more upbeat were still implemented into the show.

"The first half of pieces are really lively," he said. "We have a Johann Strauss Jr. Overture and George Gershwin's 'Rhapsody in Blue.' We presented that to really show there's hope."

The second half of the show had a darker tone, with pieces such as Giuseppe Verdi's "Chorus of the Hebrew Slaves" and Claude-Michel Schonberg's "Bring Him Home" from "Les Miserables."

"It's designed to bring home the theme," Woodard said. "Each piece on the second half was chosen because it emphasizes that there is an issue."

The orchestra and WVSU held the first iteration of the benefit concert last year, in which donations went toward replacing instruments, uniforms and other items for high school music programs affected by the June 2016 flood. The concert raised roughly $15,000 for the cause.

Not long afterward, everyone involved knew the benefit concert should continue.

"People even that day in the audience said, 'You've got to do this again,'" Woodard said. "We knew about a week out that we were going to do this again."

The Orchestra of the Hills and Chorus is "absolutely" returning for a third iteration, according to Woodard. He said he doesn't know what specific cause they will support, but added that there are "so many issues in our community that need our attention."

To donate to the CAMC Foundation, visit camc.org/ooth.

Reach Max Garland at max.garland@wvgazettemail.com, 304-348-4886 or follow @MaxGarlandTypes on Twitter.

White House official says WV can fight drug crisis with less money http://www.wvgazettemail.com/article/20170824/GZ01/170829783 GZ01 http://www.wvgazettemail.com/article/20170824/GZ01/170829783 Thu, 24 Aug 2017 19:23:12 -0400 Erin Beck By Erin Beck The acting chief of staff for the White House Office of National Drug Control Policy said, during a trip to Charleston Thursday, that West Virginia can fight the drug crisis while receiving less federal money by making sure money is "well-spent."

Sen. Shelley Moore Capito, R-W.Va., hosted Lawrence "Chip" Muir, general counsel and acting chief of staff for the Office of National Drug Control Policy, on Thursday. Muir, Capito, and staffers visited two Charleston recovery facilities, Rea of Hope and Recovery Point. Muir also answered questions after a closed roundtable discussion.

"It's hitting that critical proportion here where if you don't bring in as much attention as possible and as many resources as possible you're looking at something getting really out of control," Muir said.

More than 840 West Virginians fatally overdosed on drugs in 2016, a record number. Most involved an opioid or opiate drug, including heroin, fentanyl or a prescription painkiller. The state already had the highest overdose death rate in the nation.

President Donald Trump proposed, in a 2018 budget request, nearly $400 million in cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA). His proposed budget also anticipates $610 billion in Medicaid spending reductions over 10 years. Medicaid is the single largest payer of substance abuse and mental health treatment in the country.

Trump also supported the Republican plan to replace the Affordable Care Act, which would have cut billions from Medicaid.

Nearly one in three West Virginians are covered by the Medicaid program. In 2016, Medicaid in West Virginia covered 14,808 patients with opioid-abuse diagnoses. Medicaid paid for more than $17 million in opioid abuse-related claims that year.

Asked about the need for resources, while the presidential administration has proposed cuts to SAMHSA and Medicaid, Muir said:

"The funding issues are going to have to get dealt with and it's always a question, when you're talking about funding resources, you're also talking about the intelligent use of funds," Muir said. "So all these assessments: 'How much?' 'Where does it go?' All those questions have to get answered when the best minds are on it, so that's how you reconcile that is you have intelligent people that have looked at what's going wrong, how we got into this situation, where we've been putting the money in the past and getting into the best way to do things now. So I think it's actually quite easy to reconcile. You can spend countless amounts of dollars on a problem but if it doesn't produce the results, it's not money well-spent. Conversely what you're seeing at Rea of Hope - it doesn't take a lot of money to produce very good results for people."

"Sometimes resources are human resources," he said. "Sometimes resources are just institutional knowledge, so there's a lot of resources being deployed that are not just budget sheet resources."

Rea of Hope receives about $190,000 in state funding, and $170,000 in SAMHSA funding each year, according to Allison Adler, spokeswoman for the Department of Health and Human Resources.

The president appointed a commission on the opioid crisis, led by New Jersey Gov. Chris Christie, in March. The commission is supposed to release a report on the opioid crisis and make recommendations by October. The surgeon general's office under President Barack Obama released a similar report in November of 2016.

Nearly two weeks ago, Trump said the "opioid crisis is an emergency," but he has yet to formally declare the epidemic an emergency, which would involve allocating funding and outlining a plan.

"It's that you have to make sure that the accountability is built into the things," Muir said, "that you can't do the hurry up we need to fix a problem if it doesn't actually fix the problem, so the action steps are going to have to come out whenever we figure that these are the best things we should be doing right now and down the road.

"You have to figure out what your federal government powers are and how they interact with the state you're looking at. Whenever we talk about emergencies, we're really geared toward a huge storm that's coming, those types of emergencies. When your dealing with a public health emergency, it's been less tried."

Capito said, "The president's declaration of a national emergency was very welcome."

"I would like to see specific things but I think what I've realized in this whole thing, it's a spectrum," she added. "It's a spectrum of solutions. You can't arrest your way out of it. You can't treat your way out of it. You can't prevent your way out of it or educate your way out of it. You have to have all that."

Muir and employees of Rea of Hope spoke for nearly an hour in the kitchen of the East End women-only transitional recovery center, then took several photos.

Elaine Secrist, associate director, said many clients have used Medicaid for counseling, antidepressants and other care.

"They all have medical cards," she said, referring to Medicaid insurance cards.

The group later visited Recovery Point on Charleston's West Side. Recovery Point also receives block grants from SAMHSA.

Both Charleston recovery facilities follow the abstinence model, meaning they do not allow medication-assisted treatment.

"That was not intentional," Capito said. "That was just kind of where we ended up. We need everything."

Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.

CORRECTION: This story has been updated to correct errors describing the presidential administration's budget proposal, including cuts to Medicaid and SAMHSA.

Decrease in commercial payers leads to loss for CAMC, official says http://www.wvgazettemail.com/article/20170823/GZ0115/170829860 GZ0115 http://www.wvgazettemail.com/article/20170823/GZ0115/170829860 Wed, 23 Aug 2017 14:19:25 -0400 Lori Kersey By Lori Kersey A drop in the number of patients with commercial insurance led to a $5.1 million loss of operational costs for Charleston Area Medical Center last month, its chief financial officer told the hospital's board Wednesday morning.

Jeff Sandene said July saw the lowest percentage of commercial payers at the hospital in the last 19 months. The number of Medicaid patients also increased, Sandene said.

"We've been watching our commercial payer mix for the last 12 months," Sandene said, "Watching how much Medicaid has come on versus how much commercial business and it's all tied to the economy of West Virginia."

For July, the hospital's payer mix was 16.4 percent commercial, 25.5 percent Medicaid, 47.9 percent Medicare, 8.2 percent other government pay and 1.9 percent self pay, Sandene said.

Sandene said Wednesday the hospital was not anticipating such a low mix of commercial payers. The number of Medicaid payers saw the most growth, Sandene said.

"Medicaid doesn't cover the cost of care and that's the challenge as you have more Medicaid [patients]," Sandene said.

While Medicaid expansion related to the Affordable Care Act has helped the hospital have lower amounts of uncompensated care, Sandene said Medicare reimbursement cuts have negated those effects.

"Since the ACA has went into effect what's really happened is that is to pay for the ACA every year when they give Medicare increases they might give a Medicare increase of 2 or 3 percent, they take back three fourths of the increase to pay for the ACA," Sandene said.

Last month the hospital announced it would cut 300 jobs by the end of the year. Hospital CEO Dave Ramsey blamed poor reimbursement from governmental insurance, rising cost of drugs and technology, a nursing shortage and the cost of caring for government-insured patients for the layoffs.

Sandene said it doesn't concern him that the hospital saw such a loss in the wake of financial problems that are ongoing. The commercial payer mix has started to increase for August, he said. The hospital historically sees more commercial patients toward the end of the year, he said.

"You can have months when you dip up and down," Sandene said. "I think we're gonna see in August that trend go back and be favorable. So you'll have months that are not as favorable as others."

Reach Lori Kersey at lori.kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.