Nancy Hale, President & CEO of Operation UNITE, was asked to present testimony before the U.S. House of Representatives’ Subcommittee on Economic Development, Public Buildings, and Emergency Management on Tuesday, December 12, 2017, hearing entitled “The Opioid Epidemic in Appalachia: Addressing Hurdles to Economic Development in the Region.” Other witnesses included The Honorable Harold Rogers (R-KY), Member of Congress, U.S. House of Representatives; The Honorable Earl Gohl, Federal Co-Chair, Appalachian Regional Commission; Mr. Barry L. Denk, Director, The Center for Rural Pennsylvania; and Mr. Jonathan P. Novak, Esq., Former Attorney for the Drug Enforcement Administration. Below is the text of Hale’s full written testimony.
Good morning Chairman [Lou] Barletta [R-PA], Ranking Member [Henry C. “Hank”] Johnson [D-GA], and members of the subcommittee. Thank you for giving me the opportunity to speak with you today. I am Nancy Hale, president and CEO of Operation UNITE.
UNITE stands for Unlawful Narcotics Investigations, Treatment and Education.
Operation UNITE was launched in 2003 by Congressman Hal Rogers shortly after the Lexington Herald-Leader published a special report, “Prescription for Pain,” that exposed the addiction and corruption in southern and eastern Kentucky.
Many of us were shocked to learn that, per capita, we were the top pain killer users in the entire world.
Congressman Rogers and other local leaders feared that if we did not take swift and decisive action, an entire generation would have been wiped out. We held community meetings to find out the scope of the problem and what should be done. Teachers, preachers, parents, judges, cops. Everyone with whom he spoke had stories – personal stories. And they were ready for action.
Operation UNITE then pioneered a holistic approach in our 32-county service area that has become a model for other states and the nation. This comprehensive method involves law enforcement, treatment, and education/prevention initiatives working together. We create strategic partnerships. We provide leadership. We promote education. We coordinate treatment. And, we support law enforcement.
Why are we so concerned? Of the 32 counties in our service region, the Appalachian Regional Commission has identified 27 as being “distressed” and 3 to be “at-risk.” UNITE’s initiatives are focused on improving the education, knowledge, skills and health of residents to work and succeed.
Eastern Kentucky’s economy has been hit hard by the rising rate of substance abuse among its residents. This is especially true for local employers – including those with existing, open jobs, and those who would create new jobs. These employers are losing skilled workers to substance use, and are unable to find qualified employees who can pass a drug test, hampering their ability to run successful, growing businesses.
So how is UNITE addressing the problem?
The first pillar is Investigations/Enforcement.
UNITE has removed more than $12.3 million worth of drugs from the street, arrested more than 4,400 bad actors, achieved a conviction rate of more than 97 percent, and processed nearly 22,000 calls to our drug tip line.
But we have also long recognized that we can’t arrest our way out of this unique epidemic.
That is why Treatment is our second pillar.
Getting justice is only part of the equation. Getting into long-term recovery is what transforms substance users into healthy and productive members of their families and communities.
We staff a statewide treatment help line to connect people to resources, and have supplied vouchers to help more than 4,000 low-income people enter long-term rehabilitation. Each month our team responds to more than 1,000 inquiries from people with substance abuse disorders and their families who don’t know where to turn.
In addition, with UNITE’s assistance, the number of Drug Court programs increased from five to now serving every county in our region.
The final pillar is Education/Prevention.
We must not only cut off the supply of drugs, we must also decrease the demand. Our education programs introduce youth and adults to a life without drugs. We have reached more than 100,000 students through drug education programs and summer activities, and tens of thousands of community members have volunteered their time and resources.
In addition, through private donations, we provide $1,500 scholarships to youth who have been actively involved in UNITE programs or have been impacted by substance abuse in their families.
We also provide state-certified Drug-Free Workplace training – a necessity to attracting, retaining, and growing jobs. Certified employers benefit from reduced workers’ compensation insurance premiums, safer workplaces, increased productivity and reduced absenteeism.
A federal study by the National Center for Injury Prevention and Control conservatively estimated that prescription opioid abuse cost the economy $78.5 billion in 2013, but that did not capture the broader effect on businesses from factors like lost productivity.
A 2015 study by Castlight Health found employers spend nearly twice as much in medical expenses on opioid abusers annually than on non-abusers. Leading lab services provider Quest Diagnostics analyzed more than 10 million workforce drug tests in 2016 and found that 4.2 percent of these tests came back positive.
UNITE’s Drug-Free Workplace training educates both employees and supervisors about addiction, the signs and symptoms of drug use, the effects and costs of substance use in the workplace, and how to find treatment or other support services in the area. In addition, our staff will review existing – or help to create – an Employee Assistance Program. UNITE has provided this training to more than two dozen different companies.
According to information released in August from the Appalachian Regional Commission, overdose and opioid-related overdose mortality rates for ages 15 to 64 are 52.1 per 100,000 people in Appalachian Kentucky. That is the second highest in Appalachia and more than DOUBLE the amount for the non-Appalachian areas of the United States.
Unfortunately, our problem is not unique. Many communities are facing the same consequences from this epidemic. That is why UNITE’s efforts must continue: the enemy is evasive and persistent.
Operation UNITE has implemented many evidence-based best practices and solutions. The good news is that these programs can be replicated. The bad news is that implementing these solutions requires funding.
Support for Solving the Epidemic
As Congressman Rogers often says, “A vision without funding is a hallucination.” Operation UNITE received funding in the early 2000s through the federal appropriations process for important enforcement efforts. SAMHSA helped provide treatment vouchers.
And through AmeriCorps, we have 54 people who provide math tutoring, teach anti-drug and wellness curricula, and sponsor anti-drug UNITE clubs. The results are dramatic: Last school year, students showed an average 56.5 percent growth in math knowledge and a 51.3 percent growth in drug education and healthy decision-making knowledge.
Our achievements would not have been possible without these investments, though many of them are no longer available. We continue to explore funding opportunities through the competitive grant process but nothing specific seems to match up to our mission.
In addition to seeking private and state investments, opportunities through the Appalachian Regional Commission have been invaluable. The ARC has supported us in targeted ways that have planted seeds that are yielding fruit beyond our grandest plans. Let me share with you several key examples.
Throughout most of its existence, UNITE and its Community Coalitions have interacted with programs funded by the Appalachian Regional Commission. That relationship strengthened in 2008, when UNITE received funding to renovate an old elementary school gym and purchase equipment to create the Lord’s Gym of Jackson County – one of its most at-risk counties.
Modeled after a similar project in another UNITE county – which also received ARC funding for facility repairs – the Lord’s Gym provided a healthy, drug-free environment for youth to receive tutoring in mathematics, reading and science; provide organized physical activities for health; and support future generations to make positive decision in their lives through mentoring opportunities.
Kentucky Medical Communities UNITEd
In late 2009, our region was rocked by the murder of Dr. Dennis Sandlin, who had refused to provide pain medications to a drug-seeking patient. This was a wake-up call for our organization, as great emphasis had not been placed on engaging health care providers and medical professionals in seeking workable solutions to the drug problem.
A series of regional educational forums was conducted involving the Kentucky Office of Drug Control Policy, state law enforcement, the Kentucky Pharmacists Association, the Kentucky Hospital Association, and state legislators. This collaboration ultimately resulted in sweeping legislative changes in the prescribing and monitoring of controlled drugs, regulation of pain clinics, and mandated use of the Kentucky All Schedule Prescription Electronic Reporting system.
There was a great deal of confusion about these legislative changes, so UNITE partnered with the Kentucky Office of Drug Control Policy to stage a series of four regional training symposiums across Kentucky in early 2013. The Appalachian Regional Commission financed these forums to provide Continuing Education credits across multiple disciplines.
National Rx Drug Abuse & Heroin Summit
Perhaps ARC’s greatest and most fruitful investment in Appalachian anti-drug efforts was its early support for the National Rx Drug Abuse & Heroin Summit. In 2011, Congressman Hal Rogers recognized the need for “a coordinated national effort” to find data-driven solutions to the nation’s prescription drug epidemic. Congressman Rogers asked Operation UNITE to organize a first-of-its-kind Summit, where all impacted stakeholders could collaborate, learn from others’ successes, and foster better understanding and cooperation.
Acutely aware of the impact that substance abuse and diversion was having across Appalachia – devastating families, burdening communities, and undermining employability of the workforce – UNITE approached the Appalachian Regional Commission seeking support. Recognizing the importance of bringing the nation’s foremost experts together, the ARC agreed to serve as “Educational Partner” for the first National Rx Drug Abuse Summit, held in April 2012.
The ARC’s investment of $50,000 – double what was originally requested – has enabled UNITE to pay travel expenses for more than 200 of the country’s leading subject matter experts and leading advocates, provide audio-visual services, and offer Continuing Education credit hours each year. Attendees have been given an opportunity to learn from state and national leaders, law enforcement officials, medical professionals, community advocates, treatment experts, educators, private industry leaders, and others.
More than 700 participants – representing 45 states, the District of Columbia, and 3 other countries – attended that first Summit. The conference has grown every year since, attracting nearly 2,400 people in 2017. Registration for next year’s 7th annual Summit is currently trending 12 percent ahead. Because of ARC’s continued partnership, additional educational sessions have been crafted each year to address emerging threats and attendee demand.
Social Media Support
In 2016, UNITE received additional funding from ARC to design and implement a robust and sustainable communication and social media strategy, one that increased the capacity of Appalachian organizations to use social media effectively as they pursue substance abuse prevention and treatment activities.
As part of this initiative:
- UNITE contracted with StoryCorps to film on-site interviews. I am happy to say that one of these interviews – featuring neonatal abstinence syndrome pioneers – aired on National Public Radio earlier this year. All segments have been promoted on UNITE’s social media channels.
- UNITE provided audio-visual services for the Centers for Disease Control and Prevention to conduct a Pre-Summit Workshop on “Using Digital and Social Media to influence the #RxProblem.” This was the second-most attended workshop.
- UNITE contracted for a social media campaign on Facebook and Twitter to raise awareness of the Summit.
- UNITE contracted for a social media coordinator to assist with communications both during and after the Summit. This coordinator responded to more than 110 media requests and facilitated more than 18 on-site interviews with local, regional and national media.
- UNITE worked with Oak Ridge Associated Universities and ARC to provide technical assistance and training services to support and enhance social media needs throughout the Appalachian Region. The results of this collaboration has enabled UNITE to maintain a strong social media presence. Our number of Facebook followers has increased 24 percent since the training.
In 2016, as the Summit continued to gain national and international recognition for its quality programming and experience attendance growth, UNITE entered into an agreement with Vendome Healthcare Media to assume responsibility for promoting and staging future Summits. UNITE continues to serve as Educational Advisor and is heavily involved in steering discussion to address today’s most urgent issues.
In 2017, the ARC provided funding for UNITE to:
- Share information about media best practices at the Rx Summit, and develop promotional materials so other communities can learn about UNITE initiatives they could replicate;
- Enhance and expand its social media presence in the Appalachian Region;
- Collaborate and assist with community engagement sessions for the CDC’s new national campaign to prevent prescription opioid abuse; and
- Create a Strategic Plan and a roadmap for short-term and long-term sustainability.
The ARC understands that improving the education, knowledge, skills, and health of residents to work and succeed requires finding ways to reduce deaths from drug overdose, increase public drug awareness and education, increase access to treatment, and reduce diversion of prescription pills.
Without ARC’s involvement, the National Rx Drug Abuse & Heroin Summit would not have become the place where solutions are formulated, stakeholders convene, and change begins. UNITE has been able to showcase its unique, holistic model and position itself as a national leader in addressing substance abuse and misuse issues.
Unfortunately, there are still many people who are not aware of UNITE’s initiatives or what services we have available to share. Drastic funding cuts have forced UNITE to maintain a high level of services with a bare-bones staff, and implement strategies for long-term survival. UNITE, and other organizations trying to replicate our model, are desperate for federal support to keep the doors open. As Congress and the federal government coalesce around solutions to this epidemic, we are hopeful that we can not only maintain, but also expand upon, our partnership with ARC and other federal agencies to continue our support for individuals and communities in need.
In conclusion, UNITE, a collaborative model striving to prevent abuse of drugs and facilitate recovery, has been able to help ARC fulfill this part of its mission. And, support from the Appalachian Regional Commission – both financially and through collaborative partnerships – has enabled UNITE to create hope and change the culture, not only in our corner of southeastern Kentucky, not only across Appalachia, but on a national stage.
But we need the ARC to do more. UNITE believes funding an expansion of its Drug-Free Workplace training program would help expand economic development opportunities in Appalachia and provide valuable information to employees and their families. In addition, UNITE believes we need to push for more medical symposiums – specifically relating to prescribing, addiction, and alternative treatments.
And, of course, by supporting a national dialogue through the National Rx Drug Abuse & Heroin Summit, ARC is creating positive changes well beyond its primary service area.
Thank you allowing me time this morning to share the good things that are being accomplished in Kentucky. UNITE looks forward to working with other communities to address our nation’s opioid epidemic.