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2019-5-7

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As Hospitals Monitor Drugs, Opioid Deaths See Decline

By Katja Timm, Capital News Service

RICHMOND — Virginia hospitals are monitoring painkiller prescriptions more closely and taking other steps to curb the opioid epidemic, and the efforts may be paying off: Drug overdoses in Virginia have dropped for the first time in six years.

In 2016, the opioid epidemic was declared a public health emergency in Virginia. Fatal opioid overdoses increased steadily from 572 in 2012 to 1,230 in 2017. Last year, however, the number of deaths dipped, to 1,213, according to preliminary statistics released this week by the Virginia Department of Health.

The decrease coincided with data from the U.S. Centers for Disease Control and Prevention showing a decline in overall prescriptions of opioids — and with moves by Virginia officials and physicians to apply more scrutiny before issuing such prescriptions.

Dr. Charles Frazier, senior vice president at Riverside Health System in Newport News, said his medical practice and others across Virginia are prescribing narcotics in a more controlled and efficient way.

Frazier was involved in the creation of Virginia’s Emergency Department Care Coordination program.

Established by the General Assembly in 2017, the EDCC’s purpose is to “provide a single, statewide technology solution that connects all hospital emergency departments in the Commonwealth” for the purpose of extending and improving patient care, according to ConnectVirginia, a statewide health information exchange.

“The purpose of the EDCC is to integrate alerts,” Frazier said. “It shows us alerts of whether or not they (patients) have been in other emergency departments, information on how they were treated, with the idea being if a patient came in: Who is their primary care doctor? Who can we connect them to?”

Frazier said that in the program’s first phase, all hospitals in Virginia were required to submit a year or two of historical patient visit data to the EDCC information exchange by June 2017.

“The system is set up to alert emergency department providers and staff if the patient is a frequent emergency department patient, and also if they have been aggressive or abusive to staff,” Frazier said.

Frazier said that most of the time, the system is used to direct patients to proper care.

“I think part of the problem is if people have a hard time with transportation, they go to the ER for basic health care,” Frazier said. “If you go to the emergency room for a sore throat, for example, that can be expensive.”

The second phase of the EDCC, which was implemented last July, involves notifying primary care doctors if their patient is in the emergency department. If the system can identify a patient’s primary care doctor, it will send an alert.

“One thing we are starting to see are health systems collaborate on patients,” Frazier said. “There was a patient at Bon Secours who kept going to various emergency departments around Richmond — VCU, St. Francis, and others. With the EDCC program, they could see where they had been to, and the health systems worked together, along with the insurance company, to help the patient get the primary care they needed.”

Virginia’s Prescription Monitoring Program

Gov. Ralph Northam, a physician himself, helped create the EDCC. He also has been an advocate for the state’s Prescription Monitoring Program.

Under that program, Frazier explained, “Every time a pharmacy prescribes a controlled substance, they need to submit the information to the state — the duration, the dosage — and the system tracks how many times and how many providers have prescribed to the patient.”

Virginia Board of Medicine regulations require seeing chronic pain patients every 90 days and conducting drug screens to make sure patients are taking their medications and not taking illicit substances. Regulations also require prescribing an opioid antidote in certain high-risk situations.

“If you’re treating someone with higher dosages, the regulations outline preventative measures for overdose,” Frazier said.

Opioid overdose fatalities decline

Health officials’ concerns about opioids have grown as fatal overdoses spiked over the past decade. Preliminary numbers show that 1,484 people died from drug overdoses in Virginia in 2018. That is more deaths than from guns (1,036) and traffic accidents (958).

The total number of overdose fatalities was down slightly from 1,536 in 2017.

The vast majority of drug overdose deaths involve opioids. Of the 1,230 opioid-related fatalities last year, about 460 involved prescription medications and the rest involved heroin and/or fentanyl.

The number of prescription opioid deaths dropped from 507 in 2017 to 457 last year. On the other hand, deaths from heroin and/or fentanyl jumped from 940 to 977.

‘These numbers should give us some optimism’

In a press release, Attorney General Mark Herring thanked “advocates, families, doctors, recovery communities, elected officials, public health professionals and others who have helped reduce Virginia’s number of fatal drug overdoses for the first time in six years.”

Herring has been a strong advocate for fighting the opioid epidemic. He has taken a range of actions — from pushing to expand the Prescription Monitoring Program, to producing a documentary titled “Heroin: The Hardest Hit,” to suing Purdue Pharma, the creator of Oxycontin, on grounds that it helped create and prolong the opioid epidemic in Virginia.

“We should be heartened and hopeful to see that overdose deaths seem to have plateaued and may be starting to decline, but nearly 1,500 overdose deaths, mostly from opioids, is still a staggering number that shows this epidemic is far from over,” Herring said.

“But these numbers should give us some optimism that Virginia’s comprehensive approach — emphasizing treatment, education, and prevention, along with smart enforcement — can produce results and save lives.”

New controls on opioid prescriptions

Frazier said the biggest impact on the opioid epidemic might stem from rules imposed last year by the Virginia Board of Medicine.

“Across the state,” Frazier said, “we’ve seen a decrease in the number of opioid prescriptions and the duration of treatment for acute pain — a tremendous difference.”

Frazier said opioids sometimes are appropriate and sometimes aren’t.

“There are people who break their leg and need it for a few days, but for people who have chronic pain, they may require ongoing opioids for a long time,” he said. “While we first try non-opioid therapies, the reality is sometimes opioids are the most effective treatment for chronic pain.”

Patients can self-administer pain relief

When opioids are appropriate for treatment, health care professionals want to ensure that patients can receive their medication safely and easily. Virginia Commonwealth University Medical Center Hospitals have a specific technique allowing patients to self-administer drugs.

Samantha Morris, a care partner at the center’s Emergency Department, said narcotics can be administered directly to a patient, by the patient, with the press of a button. This involves a device called a patient-controlled analgesia pump.

“Fentanyl is usually what I see being prescribed the most, and that one is usually administered through a PCA pump,” Morris said. “It delivers some form of narcotic, usually fentanyl, and the patient presses a button to administer themselves a dose every five to ten minutes, depending on the drug.”

The amount of time a dosage from the PCA pump can be administered is based on the strength of the drug prescribed.

“I see patients mostly in the burn victim unit because they’re in a lot of pain,” Morris said.

Morris said she sees patients come in for opioid-related incidents all the time.

“It’s really difficult, because if a patient is addicted to any kind of substances, whether it’s amphetamines or any kind of narcotic to begin with, we can’t administer pain management, because it’s not going to affect the same pathway.”

SVCC Dual Enrollment Students Collaborate with Microsoft and Schneider Electric

Those who worked on the prototype insulator project are(Left to Right)Desmyn Owens, Tiffany Broadnax-Bacon, Jordan Wesson, Bryana Murphy, Philip Poole,  Ayanna Coleman, Ronnie Boyter, John Mize, Kiman McCarthy, Seita McCarthy, Justin Stansell, Vincent Brown and Scott Edmonds.

Southside Virginia Community College’s dual enrollment program is taking the student learning experience to the next level. Over the past few months,the students have been collaborating with Schneider Electric and Microsoft to rapid prototype an insulator for a DC terminal block. For these Park View High School students, this involvement has been an invaluable real-world experience.

The proposed project idea started when John Mize, Electrical Maintenance Lead for Schneider Electric, a facility management company for Microsoft, could not find an electrical cover for a high voltage electrical junction box at the Boydton datacenter. When nothing fit the specifications, he recommended working with SVCC to 3D print the part. Philip Poole, Schneider’s Critical Facility Manager drafted the design parameters and Justin Stansell, an electrical engineer for Microsoft, worked to ensure all electrical insulating properties were achieved.

The next step was involving the Advanced Manufacturing dual-enrollment students who attend class at SVCC at Lake Country Advanced Knowledge Center (LCAKC) in South Hill. 

Vincent Brown, Professor of Industrial Technologies, presented the challenge to the students.

“Simply put, I asked each student to see how they would write the code for the program and how they would solve this problem” stated Brown.

Each one quickly analyzed and researched how they would design a 3D printed electric cover. Utilizing the Autodesk Inventor program, each student inputted their design. Once this task was complete, the parts were sent to one of the 3D printers housed at the LCAKC.

Students and brothers, Kimani and Seita McCarthy, each described how they tackled the challenge.

“I measured the gap holes and then factored in an extra ½ inch gap, but this left a large gap, which was a safety issue” added Kimani.

“My approach was similar” quotes Seita, “but my overall design had to be tweaked to fit properly.”

Ronnie Boyter, and Brianna Murphy, each contributed but stressed the importance of measuring for accuracy after printing. Our main goal was to make sure our designs were safe, precise and ergonomically compliant for Schneider, they said.  

In a classroom setting producing a realistic workforce project is difficult, but when you have the opportunity to work directly with local companies the classroom training morphs into vibrant work experience. Once the fabricated prototypes were tested and modifications made, the part was approved for installation.

Recently, the students met with  Mize, Poole, and  Stansell, and explained their design methodology. As Stansell listened, he encouraged the teams to learn from each other’s design and collaborate to enhance the overall design.

Both Kimani and Seita have been accepted at Virginia Tech and will pursue degrees in engineering. Murphy has been accepted to Longwood where she is pursuing a Science degree. Boyter plans on attending SVCC in the fall to complete his degree in Industrial Maintenance. This is just a sampling of the outstanding young minds learning and growing with SVCC.

Brown, explains, “The graduates from Southside Virginia’s dual enrollment program, walk away prepared to enter the workforce or to attend four-year university. Many of the former students are now employed with Dominion Energy, Army Corp of Engineers, NASA, Newport News, MC Dean, and Rolls Royce and many local industries.  It’s exciting to be a part of a program that has such a positive impact on the lives of students .”

 “Over the course of a year, we start with students who are unsure of what direction or career path they want to pursue, but after exposure to our programs, teachers and training facility, they finish with a clear picture of the direction they want to follow,” said Tiffany Broadnax-Bacon, LCAK Center Director.

One of the goals of SVCC is to prepare students for the local workforce.  With small classroom sizes and dedicated teachers, these goals are being met. Whether you call it career, vocational, or workforce training, these dual enrollment students are immersed in technologies of the future. And that is Real World!

GOD’S GOUDA: Sisters in Albemarle County Make Cheese

The 13 Sisters of Our Lady of the Angel Monastery squeeze water from the gouda cheese before weighing Thursday morning on March 21, 2019 in Crozet, Virginia. Thursday is cheese making day at the monastery and cheese process takes about 6-8 hours from start to finish.

By: Erin Edgerton

The 13 Sisters of Our Lady of the Angel Monastery believe God has a plan for everyone. When Sister Barbara Smickel arrived on the newly purchased 507-acre farm in central Virginia in 1987, she was surprised to find an abandoned cheese barn filled with ready-to-use machinery. Without much hesitation, Smickel and the others realized God’s plan.

The first rounds of cheese made by the Sisters were in 1990.  Their semi-soft, mild Dutch-style Gouda comes in 2-pound wheels. The Sisters use it to make grilled cheese sandwiches.

Tucked in the foothills of the Blue Ridge Mountains, down a lengthy stretch off Route 250, over a bridge, through the woods and at the end of a gravel road sits Our Lady of the Angels Monastery perched on the hillside. This is where the Sisters live a self-sustained lifestyle filled with prayer, devotion and cheese making.

Their day starts around 3 a.m. with a morning prayer. By 7 a.m., Sister Myriam Saint-Vilus leaves mass early to turn on the autoclave. The windows of the cheese room grow foggy as the room heats up to a proper cheese-mixing temperature. By 9 a.m., Sister Maria Gonzalo forms ovals around steel presses, and by 11 a.m., the machines cut the sheets of cheese mixture into cubes. Sister Jacqueline Melendez takes the cubes and squeezes them into molds. They work in shifts and wear scrubs and rain boots in the barn — it’s a full-day affair.

“This work is good,” Sister Eve Marie Aragona said. “It becomes sort of mindless and allows us to work for God in ways similar to prayer and our studies.”

The sisters prepare the patio with candles and a fire for Easter service Saturday evening April 20, 2019 in Crozet, Virginia. Once the guests arrive this begins their procession into the church for Easter mass.

    

Left: Sister Maria Gonzalo, Sister Barbara Smickel and Sister Myriam Saint-Vilus practice lyrics for their Palm Sunday Mass April 12, 2019 in Crozet, Virginia. The three have been practicing all week making sure they hit every note correctly and on key. “This is will be the last night we run it, I promise,” said Smickel. Right: The wash room sits foggy on cheese making days. The cheese making process requires a moist environment.

    

Left: Sister Maria Gonzalo stirs the cheese Thursday morning on March 21, 2019 in Crozet, Virginia. Thursday is cheese-making day at the monastery and the sisters take turns coming down to the barn in shifts. The cheese is stirred in 20 minute increments, “We always say the secret ingredient is love and prayer. You get out what you put it,” Gonzalo said. Right: Sister Maria Gonzalo checks on the empty milk tank before delivery March 4, 2019 in Crozet, Virginia. "We get our milk delivered regularly and locally. We like to know where everything is coming from and exactly what gets put in," Gonzalo said.

     

Left:  Sister Maria Gonzalo opens the curtains to the milk room at the cheese barn. Thursday’s are cheese days and the sisters arrive in shifts down at the barn starting around 7 a.m. Right:  Batch 830 waits in the chilling room to be packaged and sold. The cheese barn has 3 chilling rooms and during the holidays all three can be packed.

    

Left:  Sister Eve Marie Aragona takes a break to call up to the church. Eve Marie prefers working in the cheese barn alone, “I do not really need to this about what I am doing, it is easy, peaceful work,” Aragona said. Right: Sister Jacqueline Melendez mediates during evening vespers March 30, 2019 in Crozet, Virginia.

    

Left: Sister Myriam Saint-Vilus unwraps gouda cheese in the monastery’s kitchen for Sunday’s spaghetti night March 11, 2019 in Crozet, Virginia. The sisters use their cheese for almost every meal and it never goes to waste. “How can you get sick of something that you are proud of? We know how it is made and what is in it,” said Saint-Vilus. Right:  Sister Claire Boudrau dishes out spaghetti sauce before supper. The sisters eat family style because it is another way to emphasize community and sharing of blessings. Their Gouda cheese is also served on the table.

The sisters and guests stand in silence as they light candles Saturday evening April 20, 2019 in Crozet, Virginia. This ends their procession into the church for Easter mass.

ATTORNEY GENERAL HERRING URGES FCC TO TAKE ACTION AGAINST ROBOCALLS AND SPOOFING

~ Coalition of 42 attorneys general press FCC to act further to reduce spoofed calls and texts ~

RICHMOND (May 6, 2019) – Today, Attorney General Mark R. Herring joined 41 other attorneys general in calling on the Federal Communications Commission (FCC) to take further action to stop the growing proliferation of illegal robocalls and spoofing. In formal legal comments, the attorneys general urged the FCC to adopt its proposed rules on enforcement against caller ID spoofing on calls to the United States originating from overseas, while also addressing spoofing in text messaging and alternative voice services. These provisions are included in the FCC's appropriations authorization bill also known as the RAY BAUM’S Act of 2018.

The number of spoofed calls and the consumer financial losses tied to these scams have increased by nearly 50 percent in recent years. 

“Robocalls and spoof phone calls are not only annoying but they are also potentially dangerous and could scam Virginians out of hundreds or thousands of dollars,” said Attorney General Herring. “As Attorney General, it is my job to protect Virginia consumers, which is why I have joined my colleagues today to call on the FCC to take further actions against these obnoxious and illegal scam calls.”

According to the Federal Trade Commission (FTC), Virginia was the 7th highest state in the nation for Do Not Call Registry complaints with 181,936 complaints in 2018. Additionally, Virginians made more than 118,000 complaints to the FTC about robocalls alone.

Americans received almost 18 billion scam robocalls in 2018 and overall, robocalls increased in the U.S. by 57 percent from 2017 to 2018. The FCC reports that imposter scams have reportedly cost consumers $488 million just in 2018.

Joining Attorney General Herring in sending the comments to the FCC were the attorneys general from Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Washington, and West Virginia.

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