Lawmakers and advocates discuss strategies for curbing a public health and social crisis
By John Gregory
Easy access to deadly fentanyl coupled with social disruptions caused by the COVID 19 pandemic resulted in 2,250 Kentuckians succumbing to drug overdoses in 2021. That’s more than a 14 percent increase over the previous year.
“A perfect storm is happening here,” says Kentucky Office of Drug Control Policy Executive Director Van Ingram.
While the state experienced a decrease in overdose deaths in 2018, the numbers began to tick upward again in 2019 as more illicit fentanyl began to flow into the state. Overdoses jumped 49 percent in 2020 as COVID-related closures left many individuals with substance use disorders isolated from treatment and counseling options as well as their social support networks.
Now, as the pandemic lingers and fentanyl has become even more prevalent in the commonwealth, the overdose numbers have increased again. The problem cuts across rural and urban Kentucky, and across genders and races. For example, Ingram says overdose deaths among Black Kentuckians doubled from 2019 to 2021.
The Rise of Fentanyl, the Resurgence of Meth
As America continues to battle a crisis of addiction, oxycontin has grabbed most of the headlines in recent years. But fentanyl, a synthetic opioid that started as an intravenous anesthetic in the 1960s, has slowly risen to become a silent and stealthy killer among people addicted to narcotics. Now illicit fentanyl that is 50 to 100 times more potent than morphine flows into the United States from China, Mexico, and Central America.
“The cartels are very good at what they do – they’ve been moving drugs across this country for 40 years,” says Ingram. “Maybe the drugs change, but the business operations are the same.”
But users generally don’t go looking for fentanyl. Instead, it’s often mixed in with other illicit drugs to make them more potent, or Ingram says it can be disguised as Percocet or Xanax.
“People are often buying what they think are pharmaceuticals on the street, turns out the active ingredient is fentanyl,” says Ingram. “It is deadly… It doesn’t take much to take a life.”
In fact, nearly 73 percent of the state’s overdose deaths in 2021 involved fentanyl. That compares to only 16 percent of ODs in in 2020.
Estill, Gallatin, and Perry Counties had the highest rates of overdose deaths Kentucky last year, while Jefferson County had the highest number at 569. Of those cases, 477 involved fentanyl.
“If you are looking for the drug in almost any county… you don’t have to look very far,” says state Rep. Joni Jenkins, (D-Shively), who lost a nephew to overdose in 2013.
The problem extends beyond fentanyl, though. Official say the state is also seeing a resurgence in methamphetamine use. After spiking the 1990s, meth use had been on the decline in the U.S. But meth-related overdose deaths in Kentucky increased by nearly 48 percent from 2020 to 2021, according to the state’s Office of Drug Control Policy.
“The cartels have flooded United States with really cheap, very potent methamphetamine,” says Ingram. “The cartels are selling it cheaper than you can buy the ingredients to make it yourself.”
The meth resurgence is especially challenging for law enforcement, says Ingram. While those addicted to opioids want to hurt themselves, Ingram says people using meth become paranoid, violent, and want to hurt others.
Frankfort Acts to Fight Addiction
Lawmakers have worked for years to try to combat the state’s drug crisis with a range of legislation from improving treatment options, to creating needle exchanges, to changing criminal penalties for drug trafficking.
“This problem is like a bucket with 50 holes in it,” says Sen. Ralph Alvarado (R-Winchester), chair of the Senate Health and Welfare Committee. “Government can plug a few of those holes but it you try to hold water, it’s going to continue to leak.”
Back in 2011, the General Assembly put limits on health care providers issuing narcotics and cracked down on doctors who prescribed them too much. Alvarado, a practicing physician who has been in the legislature since 2015, says lawmakers had to return nine months later to amend that law so that it would not impede helping cancer and hospice patients with pain relief.
“If a provider doesn’t do something appropriately and document things appropriately, you’re looking at a loss of a license, a criminal charge, you could serve prison time,” says Alvarado.
Other laws followed, including measures to offer liability protections to people who administer the overdose reversal drug naloxone. Jenkins says they also approved needle exchanges for IV drug users to help limit the spread of hepatitis and HIV and to encourage people with a drug addiction to get treatment.
More recent bills created pilot programs for communities to provide more wrap-around services for people in recovery and for the criminal justice system to divert offenders with a substance use disorder into treatment faster. State and federal dollars have also flowed into education programs designed to help kids avoid the allure of illicit drug use.
Earlier this year, Jenkins proposed legislation to create what she calls a safe consumption program.
“People can come in and have their drugs screened for fentanyl or other things that could hurt them, and would use their drugs with medical professionals there,” says Jenkins. “You bring people in, treat them with compassion and care, and get them on that pathway to recovery.”
Jenkins says a similar effort in New York has resulted in a dramatic reduction in overdoses. Alvarado says the idea has also worked well in Portugal, but has not been as successful in other countries. He says safe consumption legislation would likely have to come from Congress rather than state legislatures.
A Need for More than Treatment
Treatment providers are mixed on the idea of safe consumption clinics. Tiffany Hall, chief operating officer of Volunteers of America Mid-States, says it would help to bring drug use into safer environments.
“We know use is going to happen,” says Hall. “We know we can’t arrest our way out of this… so we’ve got to find ways to continue to decriminalize use.”
But Addiction Recovery Care founder and CEO Tim Robinson says he opposes safe consumption programs in favor of more direct intervention.
“We don’t have a silver bullet on this crisis,” says Robinson. “We’re going to have to take our neighbors, many of them in poverty, and help them walk back to health, and when we do that, everything changes.”
ARC operates 35 outpatient and residential treatment centers in eastern and central Kentucky. VOA offers treatment services for men and women, including a special program for pregnant women and their children, as well as initiatives to bring whole families into treatment care and to help people in recovery return to the workforce.
“One size doesn’t fit all,” says Hall. “So we’re able to offer really a large array of services to folks wherever they are on the continuum of change.”
Medically assisted treatment to help wean people off addictive substances and counseling to deal with mental health issues or multigenerational poverty and trauma are critical to recovery. Still, both Hall and Robinson say other wrap-around services are vital as well. That includes access to transportation, child care, housing, and job training.
“We can’t just plop a treatment center down in a community and say good luck,” says Hall. “It’s really a recovery ecosystem that has to happen.”
While it may take multiple cycles of treatment before a client finds long-term success, Robinson says recovery is possible.
“People need a way to make a living and for a lot of folks they have crashed their economic opportunity,” says Robinson. “(We) help take people from their crisis to career, and I think that has to be part of our strategy.”
Renee Shaw and guests discuss strategies for reducing opioid addiction rates in Kentucky. Guests: Van Ingram, Kentucky Office of Drug Control Policy; Tiffany Hall, Volunteers of America; Tim Robinson, Addiction Recovery Care; Sen. Ralph Alvarado (R-Winchester), chair of the Senate Health & Welfare Committee; and Rep. Joni Jenkins (D-Shively), House Minority Floor Leader. Show air date June 13, 2022.