Author: P Hasselbacher

Article Temporarily Withdrawn.

Yesterday I posted an article comparing opioid prescriptions in Indiana and Kentucky by specialty based on the 2013 Medicare Part-D database. Among other things, I concluded that Kentucky providers prescribe more opioids in general than Indiana providers.  On further review I discovered that the Kentucky data, but not the Indiana data, included the drug tramadol (brand name Ultram).  This would increase the apparent number of prescriptions in Kentucky and their attendant costs. Thus, while I believe most of the intra-state conclusions and my general opinions remain valid, I need to recalculate the Kentucky numbers without tramadol to make a fair comparison.  Accordingly, I will redo the Kentucky numbers and tables without tramadol and repost.

I apologize for this embarrassing oversight.

Peter Hasselbacher

[Addendum Aug 30, 2015. The original article and its supporting tables have been updated with tramadol removed from the Kentucky dataset. None of the original conclusions or opinions are materially changed.]

Epidemic Opioid Abuse in Southern Indiana– Continued.

Plenty of drugs to go around!

Louisville Magazine’s August issue included an excellent extended piece profiling the impact of narcotic addiction in Austin (Scott County) Indiana. The sensitive and insightful article by senior writer, Anne Marshall with the collaboration of photographer William DeShazer, is titled, “The Craving.”  The article deserves a wide readership and I recommend it to you.  [Not all browsers may open on-line version of the story available here.]  The title would be appropriate for a late-night horror show, but in real-life, the story is even more scary. This tiny town is ground-zero nationally for epidemics of opioid addiction, HIV and hepatitis, and the other medical and social side-effects of this class of drugs.

Based on visits and extensive interviews, the article makes clear the enormous cost of opioid addiction on entire communities. It is not just the users that pay the price.  Legal or otherwise, the presence of opioid narcotics in communities exacerbates the poverty and social isolation that provide an important foothold for drug addiction and accelerates its grasp on communities large and small. By no means, however, is opioid addiction limited to the poor. To believe otherwise is to to hide out heads in the sand and allow this horror to grow. Some accounts of the epidemics in Scott County worry that the problem might spread to Louisville. Bad news folks! I am reliably told it is already abundantly here. This story could have been written about hundreds of towns and cities, large and small all over the nation, including Louisville.

Admittedly hard to fix– Why tie our hands?
In addition to accounts of human heartbreak, the article highlights longstanding political and institutional barriers to most effectively confront a problem that has always been with us. Detox and treatment options are subject to limitations of both effectiveness and availability. Relapse rates are high. The cost of medical treatment is also high and treatment itself is subject to both provider and patient abuse. Hard to swallow is the ideologically driven political foolishness that ties the hands of those offering effective support like needle exchanges, or playing games with the funding of Planned Parenthood which was providing HIV screening to citizens of Scott County. Perhaps when it is acknowledged that opioid abuse is not limited to the poor, to minorities, or other socially marginalized people, we will hear both the public and their elected representatives singing a different song and making resources other than more prisons available. Sad to think that is what it might take! [Read today’s story in the Lexington Herald Leader about a new federal prison in Eastern-Kentucky promoted as an economic development issue and weep!] Continue reading “Epidemic Opioid Abuse in Southern Indiana– Continued.”

Nomination and Board Appointment Process At UofL Is Broken.

Summary.
The process of nominating and appointing members of the University of Louisville Board of Trustees has broken down, and– as seems to be the case for some other Kentucky universities– has been out of compliance with Kentucky law for some time. A system designed to prevent politicization of our Board and to foster gender and minority diversity has produced nothing of the kind. A major reassessment of the entire process is in order but it cannot be done behind closed doors in either Frankfort or Louisville.

When it rains on our parade, it pours.
On the same day I wrote about the statutorily impermissible imbalance of membership on the University of Louisville Board of Trustees with regard to sex and race, James McNair of the Kentucky Center for Investigative Journalism published an extensively researched article documenting the major tilt towards registered Democrats on the Boards of UofL, the University of Kentucky, and the Kentucky Community & Technical College System (KCTCS).  In a state with 53% registered Democrats, 39% Republicans, and 8% independents or other, the breakdown of appointees at the state’s three largest institutions of higher education are currently as follows:

               Dem        Rep      Other
UofL        12            3             2
UK           12            4             ?
KCTCS       7            1             –

Continue reading “Nomination and Board Appointment Process At UofL Is Broken.”

UofL Board of Trustees Under The Microscope.

Kentucky Gov. Steven Beshear is taking some heat for not including an African-American among his latest round of appointments to the University of Louisville Board of Trustees. Criticism from the community included claims that by passing over three available African-American nominees for the positions, that the Board was without an African-American member for the first time in many years and in fact violated state law.  This is incorrect.  The Board currently has as its student representative a female African-American trustee who, if she follows precedent, will not be a potted plant.  Nonetheless, attention to the makeup of the Board is a matter that should be of considerable concern to the public.  The UofL Board itself has been regularly in the news for some time, and is likely to remain there a good bit longer given rising community concern over University governance (or frequent apparent lack of governance), executive compensation, tuition increases, political contributions by Board members, probation of academic units, lawsuits against major former partners, scandals and outright criminal activities involving a few employees and faculty, high-profile separations or dismissals– including some with golden parachutes and non-disclosure agreements, a troubled partnership with a religious organization that is tearing the downtown medical center apart, or whatever other story-of-the-week keeps the pot of concern bubbling.  I confess to helping keep the heat on.  Fueled by secrecy and non-stop controversial revelations, our University’s reputation is being damaged.  Demands for accountability have past the point that they can be ignored.  It is therefore useful to examine how it is that board members of the various state universities and the community and technical colleges are selected.  The process is defined in detail by state law but it is obvious to me that existing statutory requirements are being be followed loosely if at all.  Let me explain. Continue reading “UofL Board of Trustees Under The Microscope.”