Annual drug overdose deaths in Kentucky fell for the first time since 2018. Renee Shaw, Director Of Public Affairs at KET – Kentucky Educational Television – spoke with a panel of addiction recovery advocates, survivors, and treatment providers about this finding and the work underway to ease the public health crisis of substance abuse on July 24, 2023.

During the hour-long program, “Disrupting Addiction: A KET Forum,” UNITE President & CEO Nancy Hale addressed prevention during a segment examining what policies work and what else is needed.

Hale her organization has been on the front lines of the opioid epidemic for 20 years. It offers a variety of programs across 33 counties in Appalachia with an emphasis on building coalitions, many of which involve adolescents such as the popular Camp UNITE for middle schoolers.

Spreading a message of prevention, she said, is the best way to make young people aware of their own agency – that each person has the power to refrain from experimenting with drugs, alcohol, or other substances, and each one of those individual decisions combine to make a lasting difference in communities.

“Just like we know that recovery is a lifelong journey, prevention is lifelong too,” she says. “The drug crisis is not stable. It’s ever-changing and evolving. So the need for awareness and education is lifelong. But the key to it is starting early enough.”

Here are key takeaways from the forum:

1. Overdose Deaths Decline, but More Fentanyl Use Poses Danger

In 2022, Kentucky reported 2,135 deaths from drug overdoses, down more than 5 percent from 2021. Although a positive sign, Van Ingram, executive director for the Kentucky Office of Drug Control Policy in the Justice and Public Safety Cabinet, says everyone concerned about the drug epidemic must maintain the momentum.

“We’re thrilled to have at least a reduction,” Ingram says. “Five percent, that’s over 100 families that are impacted. Kentucky was one of only eight states that saw that impact… But still, we lose six Kentuckians every day to a preventable disease.”

For decades, eastern Kentucky has experienced some of the greatest impacts from overdoses. Ingram says the problem started in the 1990s with the widespread prescription of the opioid OxyContin, which has resulted in thousands of deaths and millions of dollars in fines against pharmaceutical companies. Today, the top five Kentucky counties for drug overdoses are all located in the mountain region: Bath, Lee, Floyd, Estill, and Knott.

“You know, eastern Kentucky and Appalachia were ground zero for this entire opioid epidemic,” Ingram says. “It still remains one of the hardest hit areas in the country.”

Now the most pressing aspect of the drug epidemic, according to Ingram, involves drug pushers mixing fentanyl into heroin or other drugs and selling it to users who may not know that it has been added. Fentanyl is a synthetic opioid that is roughly 100 times more potent than morphine. It was identified in 1,548 overdose deaths in 2022, representing 72.5 percent of the state’s total.

Furthermore, Ingram explains that a growing number of opioids are laced with the animal tranquilizer xylazine. It is not a controlled substance subject to federal regulation nor is it approved for use in humans.

“It’s going to cause us to redouble our efforts and look for new ways” to spread awareness of this new and deadly problem, he says. “It’s just unbelievable – if fentanyl wasn’t deadly enough, now we’ve added something else to it.”

The epidemic has left no part of the commonwealth untouched, and it’s affected families and entire communities through several generations. Madison County Coroner Jimmy Cornelison says he has informed one family of the deaths of three sons.

Madison County reported 59 overdose deaths in 2020. Cornelison says the number spiked to 75 in 2021 and then dropped slightly to 69 in 2022. He says reported deaths are at 44 as of late July 2023, and on track for another increase. Cornelison adds that fentanyl is involved in more than 90 percent of the deaths.

2. The Value of Naloxone in Halting Overdoses, and a Potential New Therapy

The overdose reversal drug naloxone (brand name Narcan) has been used to save lives for decades, but it’s only in the past 10 years or so that government agencies have started to widely distribute the drug as an emergency treatment. Earlier this year, the Food and Drug Administration approved an over-the-counter naloxone spray that will be available in stores this fall.

“That Narcan distribution has helped people survive,” says Eric Friedlander, secretary of the Kentucky Cabinet for Health and Family Services. “You can’t get to treatment if you’re dead, you can’t turn your life around if you’re seeing the coroner. These are the things we have to do to keep people alive, to get them to treatment.”

Friedlander says Narcan is covered by Medicaid and many private insurance policies. He and his team at CHFS are leading a statewide effort to educate the public about Narcan’s effectiveness, where to get it, and how easy it is for a layperson to administer. “It’s not that hard – you can learn how to use it, it’s pretty simple,” he says.

According to federal data, nine out of 10 Kentuckians with substance use disorder go untreated. Dr. Devin Oller, a primary care and addiction medicine physician at the University of Kentucky College of Medicine, attributes that troubling statistic to a lack of evidence-based treatment in many parts of the state along with long-held stigmas about drug use. He says that labeling substance use disorder as a choice rather than a chronic brain disease is not supported by medical evidence.

“Many of my patients explain to me that in active addiction it feels like their brain has been hijacked and there’s only one destination in mind: to obtain that substance, to get out of withdrawal,” Oller says. “It takes incredible courage to say, ‘I’ve had enough.’ So, what we need to do is to give patients the tools and the skills not just to take back ownership and get back in that pilot’s chair, but to really be able to aim their destination towards long-term recovery.”

Oller supports medication-assisted treatment (MAT) to help patients achieve recovery. The two main drugs used for this are buprenorphine (which can be combined with naloxone under the brand-name Suboxone) and methadone.

“I don’t have any medication for heart failure or diabetes as effective in terms of reducing death as buprenorphine and methadone,” Oller says. “It’s a 50 percent drop in mortality if I’m able to get folks started.”

Medication-assisted treatment should be adopted in more settings, Oller argues, and he hopes it will be provided more often to persons incarcerated for illegal drug activity. Making MAT available to prisoners in a controlled setting can start them on recovery before they are released, he says, with support continuing as they re-integrate into society.

Earlier this year, officials from the Kentucky Opioid Abatement Advisory Commission announced a proposal to fund research on the potential effects of the psychedelic drug ibogaine to help patients with opioid withdrawal. The commission, which was established by legislative statute and operates out of the Attorney General’s office, is considering directing over $40 million toward this research, despite the fact that ibogaine – a plant-based compound – is classified as an illegal, Schedule I controlled substance in the U.S.

Bryan Hubbard, executive director and chair of the commission, says this potential funding decision is based on promising preliminary studies.

“We are still very much in the exploratory phase,” Hubbard says. “Observational data suggests that ibogaine could be added to the existing treatment options that we have, and that it may present a breakthrough opportunity to pioneer an additional therapeutic that can deliver some fairly dramatic results, at least when it comes to the front end of the long-term recovery process.”

Early findings suggest ibogaine can restart the brain’s natural production of the hormones serotonin and dopamine within 48 to 72 hours, Hubbard says, which can eliminate a person’s physical dependence on opioids to trigger that release. However, other research found that some persons taking ibogaine experience major cardiac events that have been fatal in some cases. Hubbard says those studies assessed patients taking ibogaine from unregulated providers overseas. He says any research funded by the Kentucky commission will be for studies conducted in approved and controlled clinical settings.

3. Recovery Centers Treat Root Causes of Addiction and Build Life Skills

Many organizations throughout the state offer short- and long-term counseling and support services to help those with addiction end their habit permanently and gain skills to help with employment and self-improvement. One such entity is Isaiah House, a faith-based addiction treatment center that will soon have eight campuses in Kentucky.

“A typical day in treatment will consist of clinical groups, individual (sessions) with a therapist, and peer support,” says Isaiah House outpatient program administrator Alicia McGee. “Peer support is a really unique and great service where you’re talking to people that have been in sobriety – they have that certification now, they’ve been where that person is.”

Another nonprofit that provides comprehensive recovery services is Volunteers of America Mid-States, serving Kentucky, Indiana, Tennessee, and West Virginia. It operates Freedom House in Louisville, a residential program which helps mothers who are struggling with addiction as well as children and extended family members that are affected. Jennifer Hancock, president and CEO of VOA Mid-States, says VOA expanded the Freedom House model to eastern Kentucky several years ago and plans to open facilities in Owensboro, Stanford, and in northern Kentucky.

Hancock says that many people with addiction also are diagnosed with a mental health disorder such as trauma, depression, and/or anxiety. Freedom House focuses on addressing the underlying mental and emotional conditions that lead women to abuse drugs or other substances even as they are tasked with raising children.

Freedom House also treats children in an age-appropriate setting with the goal of breaking the cycle of addiction. They also work to reduce the incidence of neonatal abstinence syndrome, which occurs when a baby experiences withdrawal from opioids he or she was exposed to in the womb. Hancock notes that the average hospital stay in Kentucky for an infant exposed to opioids prior to birth was 18 days in 2022. She says the average hospital stay for infants in the Freedom House program was 3.5 days.

“We see the results of this model every single day,” she explains. “We’re treating trauma, we’re not just treating symptoms, we’re treating root causes (of addiction), and we’re doing it in an intergenerational way.”

Hancock says the program at Freedom House is designed to assist families over a three-year period and involves assistance with education, employment, housing, and other areas. “Really developing an ecosystem for these families and individuals affected by addiction and recognizing that it’s on us for the long haul, it just can’t be an overnight treatment experience,” she says.

Kungu Njuguna, an attorney and a policy strategist for ACLU of Kentucky, says he found long-term recovery from alcohol, heroin, and meth addiction at The Healing Place, a campus in Louisville founded in 1989 as a homeless shelter.

“The system gave me incarceration and fines and fees I couldn’t pay. What I needed was help. I needed a mental health bed, I needed a detox bed, I needed to go to recovery,” he says. “Eventually I found my way to… The Healing Place, and I went through their long-term recovery program. I was there for about nine months.”

Now in his seventh year of recovery, Njuguna helps others struggling with addiction by advocating for legislation to expand treatment services in the commonwealth.

“Addiction took everything from me, and recovery has given it all back, plus more,” he says.

4. What Policies Work and What Else Is Needed

“I think that over the past eight years or so, maybe a little longer, we’ve put some very strong policies in place, and I think we’re beginning to see the benefit,” says state Rep. Kim Moser (R-Taylor Mill), chair of the House Health Services Committee. “The General Assembly has really put a lot of evidence-based solutions in place. We started with standards of care in treatment, that was a very early intervention, and we’ve done everything from (providing) funding for more treatment beds, we’ve addressed transitional housing, we’ve addressed re-entry, we are putting a lot of the puzzle pieces together.”

Eric Friedlander from CHFS says the 2023 General Assembly passed laws to bolster diversion programs that treat persons with addiction rather than incarcerate them. In addition to pushing for more treatment beds, Friedlander says the cabinet recently announced plans to launch a mobile crisis program that will send providers into communities to help people in their own environment, including homeless individuals.

“These are the things that we have to do as a community,” he stresses. “Because if we don’t, we end up paying incarceration costs, we end up paying costs across all communities.”

Kentucky’s effort to expand distribution of the overdose reversal drug naloxone is part of a broader movement known as harm reduction. It focuses on policies designed to reduce negative public health outcomes and steer drug users toward treatment.

The Estill County Health Department operates a syringe exchange service for intravenous drug users with the goal of preventing the spread of infectious diseases such as Hepatitis C and HIV. Health workers Mandy Watson and Candie McMaine say they serve everyone in the county, not just a vulnerable population of people who are often stigmatized.

“The harm reduction program is not (designed) to keep someone using drugs, it’s to protect the community,” McMaine says. “And that means to protect drug users as well as other people within the community, and a way to do that is to give them clean needles so they’re not sharing.”

Watson and McMaine build relationships with participants in the syringe exchange program and, when the time is right, suggest the option to enter treatment. The Estill County mobile harm reduction clinic is one of over 60 in the commonwealth serving individuals who largely existed outside the health care system before exchange programs became legal in 2015.

“There’s a lot more that goes on in these places than just exchanging needles,” Van Ingram says. “The opposite of addiction is connection – people need a connection. Syringe service programs start to provide that… They’re just so important to the big picture.”

Nancy Hale, president and CEO of Operation UNITE in eastern Kentucky, says her organization has been on the front lines of the opioid epidemic for 20 years. It offers a variety of programs across 32 counties in Appalachia with an emphasis on building coalitions, many of which involve adolescents such as the popular Camp UNITE for middle schoolers.

Hale says spreading a message of prevention is the best way to make young people aware of their own agency – that each person has the power to refrain from experimenting with drugs, alcohol, or other substances, and each one of those individual decisions combine to make a lasting difference in communities.

“Just like we know that recovery is a lifelong journey, prevention is lifelong too,” she says. “The drug crisis is not stable. It’s ever-changing and evolving. So the need for awareness and education is lifelong. But the key to it is starting early enough.”

Adapted from release written for KET by Patrick Reed.