Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

The state’s largest provider of drug and alcohol treatment is making further cuts in staff and facilities as it faces steep cuts in Medicaid payments from the government health plan that covers nearly all its clients.

Addiction Recovery Care, or ARC, based in Louisa, said it will temporarily close four programs and reduce staff as it plans for cuts of 20% or more from some of the private insurance companies that process and pay most of the state’s Medicaid claims.

The cuts to ARC programs in Boyd, Jackson, Fleming and Pulaski counties follow ARC’s announcement last month it was restructuring some programs and laying off staff after the insurance companies, known as managed care organizations, or MCOs, first notified ARC of the pending cuts.

In a statement, ARC said it remains committed to providing substance use disorder treatment across Kentucky.

“These decisions were not made lightly, and we are dedicated to supporting our team members and communities affected by these changes,” said Vanessa Keeton, ARC vice president of marketing. “Above all, the safety and care of our clients remains our top priority. We are still available 24/7/365 for patients and families in need.”

The cuts come as the MCOs, including Wellcare of Kentucky Inc., are announcing broader reductions in Medicaid reimbursement to other addiction and behavioral health programs that will limit their ability to provide care, said Frankfort lawyer Anna Stewart Whites, who represents about 20 smaller treatment providers.

For example, one of her clients, a small children’s therapy program in Berea, was recently notified of cuts, she said.

“It appears to be very much across the board,” she said.

Wellcare is the largest of six MCOs that manage Medicaid claims for Kentucky, with about 418,000 enrollees.

It did not immediately respond to a request for comment.

ARC’s cuts are the latest setback for the fast-growing, for-profit company that last year took in $130 million in state Medicaid funds and has expanded from a single halfway house to a statewide network of recovery programs and residential centers in 24 counties across Kentucky.

In July, the FBI announced it was?investigating ARC?for possible health care fraud and asking anyone with information to contact the federal agency. ARC said it stands by its services and is cooperating with the investigation.

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

ARC and its founder and CEO Tim Robinson have emerged as prolific political donors in recent years.

A?Lantern analysis?by Tom Loftus showed that Robinson, his corporations and employees have made at least $570,000 in contributions to Kentucky political causes and candidates over the past decade as his company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients.?

ARC said it has provided treatment for 75,000 people over the past 15 years.

‘Set back addiction treatment?’

The MCOs contract with the state to manage most of its $1.5 billion a year Medicaid program and have broad latitude in setting rates with providers. They are? paid a fixed rate per member and reimburse providers for care.

In July, ARC was among providers who testified before a legislative committee, warning that cuts by MCOs in payments for addiction treatment could hamper progress Kentucky has made in treatment for several decades of widespread addiction and overdose deaths.

An expansion of treatment services was fueled by expanded Medicaid payments in 2014 for substance use disorder under the Affordable Care Act.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for?Addiction Recovery Care, or ARC, told the interim Health Services Committee. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Last month, Frontier Behavioral Health, based in Prestonsburg, filed suit against Wellcare over rate cuts of 20% and a new requirement that it review all services before agreeing to pay for them. That lawsuit is pending.

Its lawsuit said that when Frontier tried to follow up with Wellcare over an August letter notifying it of cuts, the number provided in the letter for questions had been disconnected.

‘Booting’ out clients

Whites said some providers she represents have had similar experiences — or worse.

When some providers tried to contact Wellcare about rate cuts, it responded by canceling their contract altogether.

That forced clients in the midst of treatment to find another provider or switch to another MCO, both of which mean delays in care. Some providers have continued to offer treatment without reimbursement until clients can make the necessary changes, she said.

“The risk of booting someone out of your program and finding someone who can take them is just too much of a risk,” Whites said.

ARC’s Brown didn’t immediately identify how many employees will be affected by the reductions announced Wednesday. Prior to the staff cuts last month, it employed 1,350 people.

Programs to be closed temporarily are: Sanibel House in Bloyd County; Beth’s Blessings in Jackson County; Belle Grove Springs in Fleming County, and Lake Hills Oasis in Pulaski County.

Brown said clients will be offered placement in other ARC programs or the option to change to a different provider to continue treatment.

Meanwhile, he said ARC continues to negotiate over the pending rate cuts.

“We are very hopeful to have these negotiations done soon,” he said.

He said lawmakers, state officials and providers are working “to create a solution that preserves access to treatment and long-term recovery.”

Photos of fentanyl victims are on display at a memorial at the U.S. Drug Enforcement Administration headquarters in Arlington, Va. Federal data shows that overdose deaths are rising in Western states even as many states in the East are seeing improvement; the spread of fentanyl may explain much of the geographic movement, experts say. (Alex Wong/Getty Images)

Despite an encouraging national dip in the past year, overdose deaths are still on the rise in many Western states as the epicenter of the nation’s continuing crisis shifts toward the Pacific Coast, where deadly fentanyl and also methamphetamine are finding more victims.

Overdose deaths remain sharply higher since 2019. Many states are working on “harm reduction” strategies that stress cooperation with people who use drugs; in some cases, states are getting tougher on prosecutions, with murder charges for dealers.

Alaska, Nevada, Washington and Oregon have moved into the top 10 for rate of overdose deaths since 2023, according to a Stateline analysis of federal Centers for Disease Control and Prevention data. Meanwhile the biggest one-year improvements were in Nebraska (down 30%), North Carolina (down 23%), and Vermont, Ohio and Pennsylvania (all down 19%).

In Kentucky, overdose deaths declined 18% since 2023. But fatal overdoses remain high in Kentucky at 43 per 100,000 population, the nation’s ninth highest rate.

The spread of fentanyl, a synthetic opioid that can cause overdose and death even in tiny amounts, explains much of the east-to-west movement in the number of deaths, said Daliah Heller, vice president of overdose prevention program at Vital Strategies, an international advocacy group that works on strengthening public health.

“Fentanyl really came in through the traditional drug markets in the Northeast, but you can see this steady movement westward,” Heller said. “So now we’re seeing overdoses going up on the West Coast while they’re going down dramatically on the East Coast.”

The provisional CDC data estimates drug overdose deaths in the year ending with April 2024, and nationally they decreased by 10%, with more than 11,000 fewer deaths than the year before. But they’re still rising in 10 states and the District of Columbia, including 42% in Alaska, 22% in Oregon, 18% in Nevada and 14% in Washington state. Deaths climbed by almost 1,300 in those states and others with more modest increases: Colorado, Utah and Hawaii.

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Experts are still debating why some Eastern states hit early in the overdose crisis are seeing improvements.

“There’s some kind of improvement spreading from east to west and we don’t know exactly what it is yet. Everybody sees their little piece of the elephant,” said Nabarun Dasgupta, a scientist specializing in opioid disorder and overdose at the University of North Carolina’s Injury Prevention Research Center.

In North Carolina and other states with recent improvements, “it feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren’t really cooling down,” Dasgupta said.

It could be a result of better acceptance of harm reduction policies to help those who use drugs, including no-questions-asked testing of street drugs and providing naloxone to counteract overdoses. Or users may simply be getting more wary of fentanyl and its dangers and unpleasant side effects, Dasgupta said.

"It feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren't really cooling down." - Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center

“Fentanyl is very potent, but potency isn’t the only thing. Otherwise we’d all be drinking the highest proof IPAs (India pale ales),” Dasgupta said.Alaska now has the nation's second-highest rate of drug overdose deaths, about 53 per 100,000 population, behind only West Virginia (73 per 100,000). Other Western states that are now in the top 10: Nevada (47 per 100,000), Washington state (46 per 100,000) and Oregon (45 per 100,000).

The CDC data shows Alaska had the largest increase from 2023 — up 42%, to 390 deaths. Republican Gov. Mike Dunleavy in August 2023 proposed legislation making fentanyl dealers subject to murder charges in overdose death cases, writing: “Drugs and drug overdoses have had a devastating effect on our state.” The legislation was signed into law this year.

In May, the state kicked off “One Pill Can Kill,” a national?awareness campaign?warning about the dangers of fentanyl.

Fentanyl, mostly in the form of counterfeit 30 mg oxycodone pills, has become tremendously profitable for smugglers in Alaska who make use of airline passengers and air shipments of other products to get drugs into the state, said state Department of Public Safety spokesperson Austin McDaniel. Pills that sell for less than $1 near the U.S. southern border with Mexico can fetch $20 in Alaska, McDaniel said.

“We want to make the dealers think twice about targeting Alaska,” said Alaska state Rep. Craig Johnson, an Anchorage Republican, who supported the bill signed into law July 12.

Johnson’s 23-year-old nephew died of a fentanyl overdose two years ago. “This is personal. I don’t want other Alaska families to go through what we went through. I hope we never have to use it, because that will mean nobody else died.”

Other state and federal authorities are also trying a more punitive approach to the fentanyl crisis: Under a state program in Wisconsin meant to ferret out suppliers, three people were arrested in September and charged with first-degree reckless homicide in the fentanyl overdose death of a 27-year-old man.

In Michigan, two men pleaded guilty this month to federal charges in a mass fentanyl poisoning that led to at least six deathsSuch punitive approaches can backfire, experts say, if they drive people toward more dangerous solitary drug use — where no one can see an overdose and try to help — and away from programs such as free testing to unearth fentanyl hidden in other drugs.

“It’s sort of nonsensical, like saying you can beat something out of people. People are still going to use drugs,” said Heller, of Vital Strategies. “This should be a call to action to wake up and really invest in a response to drug use as a health issue.”

In Nevada, health authorities in the Las Vegas area are stressing more cooperation with residents who use drugs, increasing naloxone distribution and encouraging people to submit their drug purchases for testing so they’re not surprised by counterfeit heroin, methamphetamine or other drugs that are increasingly cut with cheaper fentanyl, said Jessica Johnson, health education supervisor for the Southern Nevada Health District.

For second year in a row, Kentucky overdose deaths decrease?

A state office coordinates goals for county naloxone distribution based on factors such as hospital reports of overdoses. More overdoses trigger more naloxone distribution to community centers, clinics, entertainment venues and even vending machines.

One puzzle in Nevada and in other states is that increasingly, overdoses involve a combination of opioids, such as fentanyl, along with stimulants such as methamphetamine. Almost a third of overdoses in Nevada are caused by both being used together, according to a state report based on 2022 data.

It could be that some people seek the “roller coaster of effects using a stimulant like methamphetamine and a depressant like fentanyl or heroin,” Jessica Johnson said, but mostly she hears that unsuspecting users get cocaine or methamphetamine that’s been cut with cheaper fentanyl.

“We get people saying, ‘Oh I don’t need naloxone because I don’t use fentanyl,’ and our team is able to say, ‘Well, our surveillance data actually suggests there might be fentanyl in your methamphetamine’ or whatever it is.”

Nationally, both drugs are increasingly a factor in fatal overdoses: Synthetic opioids such as fentanyl contributed to 68% of overdose deaths in this year’s CDC data, up from 48% in 2019. Stimulants such as methamphetamine were factors in 35% of deaths, up from 20% in 2019.

Heroin and other partly natural opioids, such as oxycodone, have diminished as factors, together accounting for 13% of deaths in the latest data compared with 40% in 2019.

Some experts theorize that the high potency of fentanyl makes those who use drugs want to tweak or balance the effect with methamphetamine. Fentanyl itself is often cut with xylazine, a non-opioid animal tranquilizer — often known as “tranq” — that can cause unpleasant side effects, including extreme sedation and skin lesions, Dasgupta said.

“During the pandemic, there were a lot of reasons why people were using substances more. Now that things are different, people are tired of the adulteration, the sedation, the skin wounds,” Dasgupta said. “People may take lower doses, and that in itself can help lower overdoses.”

This story is republished from Stateline, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

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The 83-page court document says Express Scripts is “at the center of the opioid dispensing chain.” (Photo by Getty Images)

Kentucky Attorney General Russell Coleman has sued a pharmacy benefits manager he says played a “role in worsening the deadly opioid crisis in Kentucky.”?

The complaint, filed in Jessamine County Circuit Court Wednesday, names Express Scripts and affiliates as defendants and targets alleged practices over the last two decades.

“The opioid crisis was fueled and sustained by those involved in the supply chain of opioids, with manufacturers, distributors, pharmacies, and Pharmacy Benefit Managers …including Express Scripts, each playing a role,” Coleman wrote in the suit.?

The 83-page court document says Express Scripts is “at the center of the opioid dispensing chain.” It also accuses the company of “colluding with Purdue Pharma and other opioid manufacturers in the deceptive marketing of opioids in order to alter perceptions of opioids and increase their sales,” among other things.?

It also accuses the company of:

• Colluding with Purdue Pharma and other opioid manufacturers to restrict or eliminate utilization management tools on national formularies that would have limited opioid prescribing and/or dispensing.?
• Deciding not to act on the vast amount of data and other information they had about the epidemic in order to limit the overflow of opioids into communities throughout the United States, including in Kentucky.?
• Dispensing prescription opioids through their mail order pharmacies without effective controls against diversion, in violation of Kentucky law and federal law.?

A spokesperson for Express Scripts’ parent company, Evernorth, has not yet responded to a Lantern request for comment.?

The lawsuit says its purpose is to “abate public nuisance caused in substantial part by these Defendants’ unreasonable acts and omissions fueling the opioid epidemic.”?

“Express Scripts’ central role in the opioid crisis was facilitated by their unique combination of knowledge and power that provided them with the extraordinary ability to control the opioid supply throughout the United States.”

He is seeking a jury trial, among other relief.?

“The opioid-fueled drug crisis is the greatest tragedy of our lifetime. It has stolen loved ones, drained scarce public resources and inflicted generational harm on Kentucky communities large and small,” Coleman said in a statement. “Express Scripts and the other pharmacy benefit managers amassed an unprecedented level of power, using it to push opioid pills and conceal unlawful activity. They must be held to account for profiting off Kentucky families’ pain.”?

Read Commonwealth of Kentucky v. Express Scripts

John Bowman, Kentucky campaign organizer for Dream.Org. (Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — Kentuckians in recovery say the state needs to better educate youth about addiction, digitize expungement for certain crimes and make harm reduction and community-based services more widely available to combat overdoses.?

About 30 people gathered at the Women’s Healing Place in the West End of Louisville Wednesday as part of a “Public Health is Public Safety” tour aimed at finding solutions to the opioid crisis and raising awareness about what addiction looks like person to person.?

That tour has made six stops across the state this year — in Ashland, London, Bowling Green, Hopkinsville, Lexington and, now, Louisville.?

John Bowman, Kentucky campaign organizer for Dream.Org, which organized Wednesday’s panels, said drug criminalization often drives people to harder substances.?

“We made all these laws on prescription opioids. Everybody went to heroin. We made stricter laws on heroin. Everybody went to fentanyl. We’re making stricter laws on fentanyl, and everybody’s going to xylazine,” he said. “The measures that we’ve got in place now are really, really making it hard for us to keep getting the overdose rates lower.”?

Bowman also worries a 2024 law that supporters called the “Safer Kentucky Act” and opponents said would criminalize homelessness could cause overdose deaths indirectly.?

Another provision of? House Bill 5 created a first degree manslaughter charge when a person “knowingly sells fentanyl or a fentanyl derivative to another person,” which results in that person’s death.?

“It’s kind of like a drug-induced homicide law,” Bowman said. “And it’s going to make folks scared to call 911.”?

Carson Justice, a 17-year-old from Eastern Kentucky who said addiction has affected her entire community, including her parents, said the state should invest in more harm reduction and less criminalization.?

“Instead of bad policies like House Bill 5, we could have prison after care, we could have harm reduction resources, we could have IDs, we could have all kinds of things,” she said.?

By focusing more on harm reduction, she said, “Not only could it save us thousands of dollars, it could save thousands of lives.”?

Lawmakers should also focus on revamping reentry programs, lowering what counts as “intent to distribute” and ensuring people can access a full range of treatment while incarcerated, Bowman said.?

Several panelists who discussed their treatment and recovery echoed that point, saying they did not have access to help while behind bars.?

Amanda Bourland, who has lived through addiction and incarceration and is now the vice president of mission advancement at Recovery Now, said “when I got out of prison, there were no resources for me.”?

“Four years in prison, in a row, and nobody said, ‘would you like to learn how to live a life in recovery?’ Nobody said, ‘do you think you have a problem with drugs and alcohol?’ Bourland said. “What they said was, ‘Chow ladies.’ ‘Lights out ladies.’ ‘Meds, ladies.’ That was it.”?

‘Trauma is the gateway’?

Over the course of three hours, two panels and a series of small group discussions at the women’s campus of The Healing Place, advocates and people in recovery emphasized that widespread access to harm reduction is key to lowering the number of Kentuckians dying from overdose.?

Harm reduction is anything that decreases the harm a person may experience — like wearing a seat belt when driving or brushing teeth to avoid cavities. In the context of substance use, harm reduction includes the use of the overdose-reversal Narcan, fentanyl test strips, syringe exchange programs and more. Harm reduction emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, says the Substance Abuse and Mental Health Services Administration??

Stigma sometimes stands in the way of recovery, advocates said.?

“In this country, we still view substance use disorder as a moral failing,” said Tara Hyde, the CEO of People Advocating Recovery who is also in long-term recovery. “And until we, as a community, really gather together and really start to create more of an argument against that narrative, they’re going to continue with that, because that’s all that they know.”?

Stephanie Johnson with Vocal KY said the word “addiction” is still quite stigmatized — and asked the audience, “how many people would not move or have gotten dressed without a cup of coffee this morning?”?

“Changing the narrative,” she said, “is harm reduction.”?

Focusing on mental health for people in active addiction and recovery is also “huge,” Johnson said.?

“You can have a mental health issue without having a substance use issue,” she said. “You will not have a substance use issue without having any mental health issue. We have got to address mental health. Trauma is the gateway.”?

Youth education and recovery funding?

Lawmakers should codify a requirement for schools to have uniform education on mental health, Hyde told the Lantern. There are “quality” programs available, she said, but “there’s no requirement, so not every school gets that.”?

“This is a systemic problem. And we can’t just, (say) ‘oh well, this school has it, and this school doesn’t,’” she said. “You can’t just make it bounce like that; that’s a really big problem.”?

The state could also save itself money, Hyde said, by funding long-term recovery programs. Usually a person attempts recovery an average of six times before being successful, she said, meaning their treatment could cost around $180,000 by the end of those attempts, which are usually in short-term programs.?

Some research suggests longer programs are more effective, especially in dealing with severe cases.?

“A lot of that money is already being spent,” she said. “Medicaid is paying for each attempt — six on average.”?

Justice’s mother, Beckie Rose, shared a panel with her daughter.?

She’s from Pike County — from “coal mines and coal fields and mountains,” as she described it, as well as “ground zero” of the opioid epidemic.?

Rose is in long-term recovery now, and she advocates for a better future for her daughter and Eastern Kentucky community.?

“We have way more in common than we have differences,” Rose said. “And I would just like to see our communities and our families come together, and instead of incarcerating disease, start treating disease.”??

Baptist Healthcare Corbin, above, and Westcare in Pike County are in line for federal funding to expand access to drug treatment. (Baptist Healthcare Corbin)

Two Eastern Kentucky health care providers have received $5.7 million from the Department of Health and Human Services to expand opioid treatment programs.?

Westcare Kentucky in Ashcamp and Baptist Healthcare System in Corbin received $3 million and $2.7 million, respectively. The grants will be spread over four years.?

They’ll use the funds to “create new or expand existing access points for treatment and recovery services, support the behavioral health workforce and collaborate with social services to ensure coordinated care and sustainable impact in rural communities,” according to the Health Resources and Services Administration (HRSA), which is in the Department of Health and Human Services (HHS).?

Westcare, part of a nonprofit network of behavioral health provicers, is located in Pike County, which was among the five Kentucky counties in 2023 with the most fentanyl and meth-related overdose deaths.?

In 2023, there were 1,984 fatal overdoses in Kentucky, down from 2,135 in 2022. Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

Despite the overall decrease, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.?

“We know that where you live should not determine your access to or the quality of the care that you receive,” Carole Johnson, the administrator of HRSA, said in a statement. “And, we are taking action to deliver for rural families by supporting high-quality substance use disorder treatment and by helping rural hospitals continue to serve their communities.”

Naloxone for reversing opioid overdoses is available to the public at the Lexington-Fayette County Health Department on Newtown Pike. (Lexington-Fayette County Health Department)

The Lexington-Fayette County Health Department has issued an overdose alert for Lexington.

The health department reports a spike in suspected nonfatal drug overdoses with 24 reported in four days, Sept 17-20, according to information from the Overdose Detection Mapping Application System (ODMAP).

“This is an important time to carry naloxone, used to reverse opioid overdoses, especially if you or someone you know has substance use disorder,” said the department’s communications officer Kevin Hall in a news release Friday. “Fentanyl has been found in all types of regulated drugs, so naloxone may help regardless of the drug taken.”

The department’s Harm Reduction Program provides naloxone to anyone who needs it. Naloxone kits are available 11 a.m.-5 p.m. Mondays, 3-6:30 p.m. Wednesdays and 11 a.m.-5 p.m. Thursdays in the Dr. Rice C. Leach Community Room at the Lexington-Fayette County Health Department, 650 Newtown Pike. People picking up the free naloxone also receive a 10-15-minute class in how to use it.?

The department recommends:

• Don’t use drugs alone
• If you or someone you know needs help with substance use disorder, visit https://findhelpnowky.org/ky to search for available treatment options (or call 1-833-859-4357 during business hours or 1-800-854-6813 after business hours)
• Check in on friends, family members, neighbors and others to share this information
• Call 911 if you suspect an overdose.

Community clinics will use $4.7 million in federal money to integrate mental health and substance use treatments more fully into primary care services.?(Getty Images)

Eight community health centers in Kentucky have received nearly $5 million in federal funds to launch and expand mental health and substance use disorder treatments across the state.?

The $4.7 million in grant money comes from the Health Resources and Services Administration (HRSA), housed within the U.S. Department of Health and Human Services (HHS).?

Centers will use the money to integrate mental health and substance use treatments more fully into primary care services.?

“Access to behavioral health care is critical for communities of color and underserved groups,” HHS Secretary Xavier Becerra said in a statement. “HRSA-funded health centers have a proven record of success in reaching underserved communities. This funding expands their access to essential behavioral health services that will benefit entire communities.”??

The grant money is going to these centers:?

• Cumberland Family Medical Center in Burkesville received $600,000.
• Grace Community Health Center in Corbin, $600,000.
• Health First Bluegrass in Lexington, $600,000.
• Health Help in McKee, $600,000.
• Health Point Family Care in Newport $500,000.
• Kentucky Mountain Health Alliance in Hazard, $600,000.
• Lewis County Primary Care Center in Vanceburg, $600,000.
• Sterling Health Solutions in Mount Sterling, $600,000.

Carole Johnson, the HRSA administrator, called mental health and substance use disorder treatments “essential elements of primary care, and there should be no wrong door for families to get the behavioral health care they need.”

Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

An Eastern Kentucky provider of addiction services has filed a lawsuit challenging cuts in Medicaid payments that it says threaten its business.

The lawsuit, filed Tuesday in Jefferson Circuit Court by Frontier Behavioral Health Center, is against Wellcare of Kentucky Inc. — one of six private insurance companies that handle most of the state’s Medicaid claims and establish rates for health providers.

The lawsuit is the latest development as providers and some insurance companies spar over cuts in payment. A week ago, Addiction Recovery Care, or ARC, the state’s largest provider of substance use disorder treatment, said it is laying off staff and reorganizing programs because of the reductions.

In July, ARC executives testified before a legislative committee in Frankfort to protest the cuts it said affected it and a handful of other providers.

Lawmakers join KY’s largest addiction treatment provider to oppose Medicaid payment cuts

Frontier, a for-profit company based in Prestonsburg, said in its lawsuit that cuts of 20% in payment for addiction treatment that took effect last month threaten its ability to care for patients and pay its 94 employees.

An additional, new requirement that Wellcare review services before agreeing to pay for them will further hinder operations, the lawsuit said.

“Frontier must pay its employees for their work,” it said. “Frontier does not have the luxury of delaying payroll and operational expenses until Wellcare decides whether it will pay Frontier for the medically necessary services Frontier provides to Eastern Kentucky’s vulnerable health behavioral health patients.”

Frontier sees about 50 patients a day, according to the lawsuit.

Frontier CEO Randy Hunter declined to comment on the case. Officials with Wellcare, based in Louisville, did not immediately respond to a request for comment.

Expanded Medicaid funds for addiction services that became available in 2014 have fueled rapid growth in treatment programs amid decades of growing addiction to opioids, methamphetamine and other substances in Kentucky.

Last year, Kentucky spent $130 million in Medicaid funds on addiction treatment, with most of the money from the federal government.?

Kentucky Gov. Andy Beshear has cited the growth as important in battling addiction.

As an indicator of success, the Beshear administration points to the?decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest?overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

But the business of addiction treatment has brought complaints about high costs from the six private managed care organizations, or MCOs, that handle most of the state’s $1.6 billion a year Medicaid business. The companies contract with the state and receive a fixed amount per member to cover health costs.

And it has invited federal scrutiny.

In July, the FBI announced it was investigating ARC for possible health care fraud and asked anyone with information to contact them through the agency’s website. ARC, in a statement, has said it is confident in its services and is cooperating with the investigation.

Frontier provides services in Prestonsburg, Salyersville, Paintsville and Harlan, according to its website.

It said in the lawsuit the company first learned in August of a 20% rate cut being imposed by Wellcare.

Wellcare is the largest of the MCOs that oversee health care for most of the 1.5 million Kentuckians covered by Medicaid, with around 418,000 members enrolled in its plan. The other members are divided among the other five MCOs.

The lawsuit alleges when Frontier sought to question Wellcare about the cuts, the MCO claimed it sent Frontier a letter in March 2024 notifying it of the new rates.

“Frontier did not receive any letter from Wellcare notifying it of a rate cut in March 2024,” the lawsuit said.

It said that in August, Wellcare also began sending letters notifying Frontier it was placing its services on “prepayment review,” meaning it would have to review services before deciding whether to pay for them.

The lawsuit said the letters provide a telephone number to call Wellcare with any questions or concerns.?

“The phone number has been disconnected,” the lawsuit said.

Frontier asks the court to find Wellcare in breach of its contract. It also asked for a temporary order barring the MCO from imposing “prepayment review” on Frontier services.

Claims in a lawsuit provide only one side of a case. Wellcare has not yet responded.

The case has been assigned to Jefferson Circuit Judge Annie O’Connell.

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of drug and alcohol treatment is cutting staff and restructuring some services, citing significant cuts in Medicaid reimbursement from the government health plan that covers almost all of its clients.

Addiction Recovery Care, or ARC, based in Louisa, said in a statement Thursday that, as a result of cuts in payment for addiction and mental health services, “we have had to make difficult decisions impacting some of our staff members.”

The staff cuts come after a dispute with the private insurance companies that process and pay most of Kentucky’s Medicaid claims.

ARC declined to say how many of its 1,350 employees would be affected but said “we are doing everything we can to support the affected individuals during this transition.” It provided no further details.

“Out of respect for our employees we do not discuss personnel matters,” the company said.

ARC also is reorganizing some of its operations in Louisa, the small Eastern Kentucky town where the for-profit company is based and the home of its founder and CEO, Tim Robinson.

Robinson, a lawyer and recovered alcoholic who started the company that became ARC in 2010, has emerged as a politically well-connected figure and major political donor.

A Lantern analysis by Tom Loftus showed that Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients.?

Except for money given to political committees supporting Gov. Andy Beshear, a Democrat, virtually all of the rest went to Republicans like former Gov. Matt Bevin, Attorney General Russell Coleman, U.S. Rep. Hal Rogers and candidates for the Kentucky legislature.

Beshear has praised ARC for its role in helping the state deal with the wave of addiction that engulfed Kentucky in recent decades.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at a ribbon-cutting in March for a new ARC facility in Greenup County at the former Our Lady of Bellefonte Hospital in Ashland.

A spokesman for the state Cabinet for Health and Family Services, which administers Medicaid, said that the Beshear administration supports Medicaid services for those in need of addiction or mental health treatment and is seeking ways to expand them.

As for the rate dispute between ARC and the managed care companies, those companies “are contractually obligated to ensure members have access to appropriate medical care,” the spokesman said in a statement, adding: “We have no comment on the operational structure of Addiction Recovery Care (ARC) but these provider types are an essential resource to help individuals break the cycle of addiction.”

Robinson, a lifelong Republican, has praised Beshear as a skilled political leader saying, “I hope he runs for president.”

Enter the FBI

The cuts are the latest setback for the fast-growing company that last year took in $130 million in state Medicaid funds and has expanded from a single halfway house to a statewide network of recovery programs and residential centers in 24 counties across Kentucky.

In July, the FBI announced it was investigating ARC for possible health care fraud and asking anyone with information to contact the federal agency.

An FBI spokeswoman in a statement Tuesday said it has no new information to share about the status of the investigation but said the agency is still accepting information through an online site on its website.

ARC has said it is cooperating.

“We are confident in our program and in the services we offer,” the statement said. “We, and our legal counsel, are cooperating fully in the investigation.”

A few days before news of the FBI investigation became public, Coleman, the attorney general and law school classmate of Robinson at the University of Kentucky, said he was recusing himself from any investigation of ARC, according to Louisville Public Media. It reported Coleman’s top deputy, Rob Duncan, a childhood friend of Robinson who previously has done legal work for ARC, also was recusing himself.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Coleman’s office investigates Medicaid fraud.?

Robinson, his corporations and employees gave at least $37,700 to Coleman political committees since late 2022.

‘Significant strides’ threatened

News of the FBI investigation became public just a few days after ARC executives appeared before a Kentucky legislative committee to protest cuts in reimbursement from some of the six national health insurance companies known as managed care organizations, or MCOs, that oversee most of the state’s $1.6 billion a year Medicaid program.

ARC, in a statement, stressed that cuts in reimbursement are driving the staff reductions and facility reorganizations.

“These difficult decisions are a direct result of impending and significant reimbursement cuts for many addiction and mental health service providers in Kentucky,” it said.

The MCOs contract with the state to manage care and provide payments for health services for most of the state’s around 1.5 million residents insured through Medicaid, which gets most of its money from the federal government.

In turn, the MCOs are paid a fixed rate per Medicaid member for overseeing that care.

People with knowledge of the situation have told the Lantern insurers had become concerned about aggressive billing practices and rising costs associated with some addiction treatment companies including ARC.

At the July hearing, ARC officials told lawmakers they and a handful of other providers in Kentucky had been notified they faced cuts of 15% to 20% in reimbursement from some of the MCOs.

Increased access to Medicaid funds and a growth in the treatment industry have helped Kentucky expand to the most treatment beds per resident in the country, an accomplishment touted by Beshear.

That progress could be threatened by the pending cuts, Matt Brown, ARC’s chief administrative office, told members of the interim joint Health Services Committee on July 30.

“Kentucky has made significant strides in access to treatment,” Brown said. “With these cuts it could completely set back addiction treatment in our state 20 years.”

This story has been updated with a response from the Beshear administration.

Kentucky Attorney General Russell Coleman, addressing the Opioid Abatement Advisory Commission, proposes putting $3.6 million from settlement funds into youth prevention, Sept. 10, 2024. (Photo courtesy Office of the Attorney General)

Kentucky’s Opioid Abatement Advisory Commission voted in favor of spending $3.6 million over the next two years on a three-part addiction prevention campaign geared toward youth proposed by Attorney General Russell Coleman Tuesday.?

The funds that the commission is in charge of distributing, which come from legal settlements with drug companies, “represent the shared pain of families across this commonwealth,” Coleman said Tuesday.?

He asked the commission for permission to spend a slice of this “blood money” to reach young people across Kentucky between the ages of 13 and 26. No members voted against his request, and no one abstained. The money will be split into $1.8 million each year.

Coleman’s campaign, modeled after a Florida initiative, has three parts. The first is an ad campaign called Better Without It, to be featured on social media, on college campuses and more. Coleman pointed to the well-known “Click it or ticket” campaign as an example that “these types of education campaigns can work.”?

The ads, which will also be pushed by influencers, will be tailored to Kentucky, using photographers and creators who Coleman said can make the material “look and sound and feel and smell like the commonwealth.”?

The second arm of the campaign is to “weave together” Kentucky’s “patchwork” of school-based prevention programs so kids have access to more cohesive resources. Lastly, Coleman said, the campaign will “elevate and draw attention to the ongoing work of this commission.”?

Overdose deaths in Kentucky decreased in 2023 for the second year in a row, according to this year’s Drug Overdose Fatality Report. In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and fentanyl.?

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

From 2021 to 2023, around 460 Kentuckians under the age of 34 died from overdoses, according to that report.?

“We know young people are more likely to be influenced by their peers than (by) someone who looks like me,” Coleman said. “Honest and productive conversations about the dangers of substance abuse among students can be a force multiplier.”?

People in their teens and early 20s and those with a family history of addiction are most at risk for opioid use disorder, according to the Mayo Clinic.?

“I’m asking you to zealously collaborate with us so that we can reach young people where they are to prevent them from taking their first — and in this environment, too oftentimes their last — experimentation … with this poison,” Coleman told commission members.?

Coleman said “as little as one fentanyl pill can — and is — killing our neighbors. … We live at a time where there is no margin of error. It simply does not exist. There’s no such thing as safe, no such concept or notion of safe experimentation with narcotics.”

The commission was created by the state legislature in 2021 and has nine voting and two non-voting members.?

Kentucky receives installments toward $900 million in settlements with opioid manufacturers and distributors. So far, it has awarded 110 grants worth more than $55 million toward treatment, prevention and recovery efforts.??

The commission next meets on Oct. 8.?

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of addiction treatment services, Addiction Recovery Care, or ARC, is the subject of an? FBI investigation into possible health care fraud, according to a July 30 post on a website of the federal agency’s Louisville office.

ARC, which is funded almost entirely through Kentucky’s Medicaid program, has not been charged with any crime but the agency is asking people with information to fill out an online form “if you believe you were victimized by ARC or have information relevant to this investigation.”

ARC, a for-profit company based in Louisa, and whose CEO and affiliates have emerged as prolific political donors in recent years, said in a statement from spokesman Kyle Collier that it is cooperating with the FBI.

“We have recently learned that there is a federal investigation into ARC,” the statement said. “As we all know, healthcare is one of the most highly regulated fields in the country, and addiction treatment is among the most highly scrutinized healthcare services. ARC is a trailblazer in the field of addiction services. We are confident in our program and in the services we offer. We, and our legal counsel, are cooperating fully in the investigation.”

Collier directed further inquiries to ARC’s chief legal officer, Jessica Burke, who provided a similar statement.

ARC has developed a reputation for aggressive expansion since it was launched by Tim Robinson, a Lawrence County lawyer who founded the company with a single halfway house for alcohol treatment in 2010. Fueled by the availability of new Medicaid funds for substance use disorder treatment since 2014 under the Affordable Care Act, ARC operates some 1,800 treatment beds in 24 counties and reaches hundreds more clients through outpatient services, the Kentucky Lantern reported in July.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Last year, ARC took in $130 million in Medicaid funds, the government health plan which gets most of its money from the federal government, making it by far the state’s largest provider of substance use services.

Robinson and? his wife, Lelia, own ARC and some related entities which provide them with an annual income of $533,400, according to a 2022 tax filing of a related non-profit company, Odyssey Inc.

The company has been singled out for praise by politicians including Kentucky Gov. Andy Beshear, who spoke at an ARC ribbon cutting for a new ARC facility in March.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said.

He also praised Robinson, ARC’s founder, in his State of the Commonwealth speech in January.

“With us today,” Beshear said, “is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I’m proud to say we now have more treatment beds per capita than any other state in the country.”

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to reporter Tom Loftus’ analysis in the Kentucky Lantern of campaign finance records.?

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He also gave big to?Beshear’s opponent in the 2019 governor’s race, Republican incumbent Gov. Matt Bevin.

The Lantern’s analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew.

He also has donated to Kentucky Republican lawmakers including some who wrote recent letters on ARC’s behalf, asking that rate cuts proposed to ARC and other addiction providers be suspended until further study.

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

The rate cuts of 15% to20% proposed by three of the six private insurance companies that process state Medicaid claims became public this week at a legislative hearing. ARC and another provider told lawmakers that such cuts would devastate Kentucky’s efforts to turn the tide of addiction to drugs and alcohol.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for?Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Six national insurance companies known as managed care organizations, or MCOs, handle the majority of the state’s $16 billion a year Medicaid business. Under contracts with the state, they are paid a fixed rate per member to cover the cost of care.

Brown, the ARC official, told lawmakers this is no time to cut payments for addiction services, citing some indicators of success.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest?annual?overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

In a statement released after the hearing on the cuts, the Kentucky Association of Health Plans, which represents the MCOs, said its members?“are proud to work collaboratively with quality, trustworthy?providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

The FBI posting on the website seeking information on ARC does not provide further information about the nature of the investigation,

A spokeswoman did not immediately respond to a request for comment.

A questionnaire people are asked to fill out includes several questions including whether they have been or are a patient at ARC and if so, what services were received. It also asks whether the person responding has ever made a complaint before about ARC and if so, to whom.

Addiction Recovery Care and its owner Tim Robinson have rebuilt a block in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space. (Kentucky Lantern photo by Matthew Mueller)

FRANKFORT — The state’s largest provider of drug and alcohol treatment is warning that looming cuts in Medicaid reimbursement to some providers could damage efforts to curb addiction that has engulfed Kentucky — just as the state is showing improvements.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

A handful of companies that provide substance use disorder treatment, including ARC,? have been notified they face cuts of 15% to 20% from some private insurers that handle most Medicaid claims, Brown told the committee.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest?annual overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Brown was joined by Deron Bibb, chief financial officer for Stepworks, a recovery program based in Elizabethtown, and ARC executive John Wilson, also executive director of the Kentucky Association of Independent Recovery Organizations, speaking to the interim joint Health Services Committee about the cuts.

“This will likely result in higher overdose rates, higher recidivism, more crime and incarceration,” Bibb said. “We need to understand the full scope and impact of these cuts.”

The cuts have been announced by three of the six managed care organizations, or MCOs, private insurance companies that handle claims for most of the state’s $16 billion-a-year Medicaid program, Brown said.?

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

Under their contracts with the state, the MCOs generally have authority to set rates they pay providers. The state pays MCOs a fixed amount per member to cover Medicaid costs.

One company also has begun notifying patients it will no longer cover addiction services at ARC effective Sept. 30, Brown said.

He did not identify the MCOs that have announced cuts and declined to do so after the hearing, saying ARC and other companies are still attempting to negotiate with them.

Sen. Stephen Meredith, R-Leitchfield and co-chairman of the health committee, said Tuesday the lawmakers likely would seek more testimony on the subject, including from the MCOs.

“I know there’s two sides to every story,” he said.

Wellcare, with 420,000 members, is the largest of the six MCOs followed by Passport by Molina, Aetna, Anthem, Humana and United HealthCare. Together they oversee payment of Medicaid claims for about 1.4 million Kentuckians.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Wilson said the recovery organization he represents wants to make sure lawmakers are aware of the situation and already has asked them to voice concerns.

“There’s going to be real world consequences and I think it’s important to let legislators know what’s taking place,” he said.

Some defenders benefitted from owner’s largesse

Several lawmakers have signed letters urging that the MCOs suspend any cuts to substance use treatment until the General Assembly can further review the matter. They include some in key leadership positions and some who have benefited from campaign donations from ARC founder and owner Tim Robinson and his employees.

ARC, a for-profit company based in Louisa, has emerged as the state’s largest and fastest growing provider of addiction services, financed largely by Medicaid, the government health plan with the majority of funds from the federal government. Growth took off after 2014 when substance use treatment was included in the Medicaid expansion authorized by the Affordable Care Act.

The Lantern reported the company took in about $130 million last year in Medicaid funds and was by far the largest recipient of the about $1.2 billion the state spent on substance use treatment.

The company and Robinson also have become among Kentucky’s major political donors with more than $500,000 in contributions over the last decade — with funds divided among Republican causes and those of Gov. Andy Beshear, a Democrat, the Lantern reported earlier this month, citing campaign finance and other public records.

Sen. Phillip Wheeler, R-Pikeville, who has received $19,900 in contributions from Robinson, his wife Lelia and ARC employees since 2016, on July 9 sent a letter to Kentucky Medicaid Commissioner Lisa Lee urging the cuts for addiction services be suspended “until the legislature fully understands the reasons behind them.”

“Kentucky has made great progress in tackling the addiction crisis that has touched so many of our constituents, neighbors, colleagues, friends and family members,” Wheeler said.?

Cutting reimbursement now “could negatively affect some of our most vulnerable citizens and prevent us from seeing these positive trends continue,” his letter said.

A similar letter addressed to “to whom it may concern” was signed by Rep. Patrick Flannery, R-Olive Hill, who has received about $17,000 in campaign contributions from Robinson and ARC employees.

Another letter was signed jointly by Senate President Robert Stivers, R-Manchester, House Speaker David Osborne, R- Prospect, Rep. Kimberly Moser, R-Taylor Mill and Meredith. Moser and Meredith are co-chairs of the joint Health Services Committee which heard from ARC and other treatment officials Tuesday.

Republican supermajorities control the Kentucky House and Senate.

Robinson has given $10,000 to the Kentucky House Republican Caucus, and $15,000 to the Kentucky Senate Republican Caucus in the last four years.

Robinson also has given other contributions to campaigns of Republican state legislators in the past decade including $4,100 to Moser and $2,000 to Osborne.

From 2021 through 2023, ARC companies and employees gave about $252,000 to a political committee supporting Beshear, whom Robinson, a Republican, has said he admires and would like to see run for president.

Bibb, Stepworks’ chief financial officer, gave $500 to Flannery in December 2023 and $2,500 to the Kentucky House Republican Caucus in October 2022, according to Kentucky Registry of Election Finance records.

Not asking for more money, just no cuts, says company official

Brown said that one concern of the MCOs is the cost of treatment, in particular long-term treatment for addiction.

ARC understands concerns about costs, but experience shows people with addiction benefit the most from long-term services, Brown told the committee.

“It is not just about surviving from their addiction but thriving in their communities,” he said. “Long-term treatment is vital.”

Without quality treatment, costs to the state will rise elsewhere, Bibb said.

“These costs will not go away,” Bibb said. “They simply will shift back to the emergency room, the judicial system, foster care, homelessness.”

ARC is willing to work with the MCOs and the state to ensure it is using money efficiently and effectively, Brown said after the hearing.

“Everybody’s got to be good stewards,” he said. “We’re committed to helping provide a solution.”

Brown and Wilson said representatives of treatment providers plan to meet with MCOs and state officials in coming weeks to try to resolve their differences.

“We’re not asking for more money,” Brown said. “We’re asking for no cuts.”

Wheeler, in an interview, said he appreciates the support of Robinson, a longtime friend since college together at the University of Kentucky, but that’s not why he sent the letter.

Rather he’s concerned about the impact of cuts of up to 20% on ARC’s services, which he said have helped many people in the region including a brother who benefited from its treatment program.

Also, he said, ARC is a major employer in the area where jobs have been scarce and also trains its clients for jobs.

This story has been updated with a statement from the Kentucky Association of Health Plans.

VOA’s Freedom House, a program for pregnant and parenting women who have substance use disorders, wants to improve completion rates for Black women.(Getty Images)

LOUISVILLE — The Volunteers of America chapter that includes Kentucky will spend $123,000 over the next nine months to make sure more Black women get access to treatment for substance use disorder.?

Volunteers of America Mid-States is using this grant money, which came from the Kentucky Association of Health Plans, to fund a new initiative called Access Justice.?

With the grant money, scholar, writer and activist Brandy Kelly Pryor will specifically evaluate VOA’s Freedom House, which is a program for “pregnant and parenting women” who have substance use disorders. Her report is due April 2025.?

The 31-year-old program, with locations in Louisville and Manchester, also lets minor children (under the age of 18) stay with their mothers during treatment. Kelly Pryor will primarily study Louisville and potentially branch out elsewhere at a later time.?

Jennifer Hancock, the president and CEO of Volunteers of America Mid-States, told the Lantern this move is in direct response to the high rates of maternal mortality among Black women and the disproportionately high overdose rates among Black Kentuckians.?

Kentucky overdose deaths decreased in 2023 for the second year in a row, according to the Drug Overdose Fatality Report.?

In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and fentanyl.?

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

Despite the overall decrease, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023, the Lantern previously reported.?

A 2023 state report on maternal mortality also showed substance use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky – 88% — are preventable, that report from the Cabinet for Health and Family Services said.?

Freedom House locations have also seen lower program completion rates for Black Kentuckians, Hancock said.??

“I think some of it is about the stigma that they face coming into treatment,” Hancock said. “I think that there could be some cultural and familial pressures that they experience disproportionately.”?

Kelly Pryor’s study is expected to provide answers as to why Black Kentuckians leave the Freedom House program without completing it, she said.?

“Women, generally speaking, have to be convinced that they deserve treatments and that they are worthy of getting this help and support versus trying to do it on their own,” Hancock said.?

In her analysis, Kelly Pryor will “identify gaps in care and opportunities for improvement, ensuring that substance use disorder recovery services are equitable and accessible for everyone who needs them,” VOA said.?

The nonprofit will then come up with plans to fill any gaps in care and access.?

Hancock doesn’t know if the solution will be “an internal-to-VOA process that needs to be improved, or if it’s more of a public campaign that we need to wage to reassure Black women that they’re worthy of treatment, that treatment is a place where they can feel supported and feel seen and heard.”?

“I haven’t reached any conclusions around that,” she said. “I’m remaining really curious at this point in time.”?

The measure of success, Hancock said, will be when VOA and Freedom House start seeing “better engagement rates of Black women” and higher program completion rates.?

“Building on principles of healing justice, we will ensure a process that facilitates those most affected, leading us toward the best solutions for recovery and prevention,” Kelly Pryor said in a statement. “This effort will take time and involve critical self-reflection, yet the return will have an indelible impact on Kentucky and beyond.”

Kentucky Gov. Andy Beshear and his vice presidential prospects had been the center of speculation in his home state for weeks. (Kentucky Lantern photo by McKenna Horsley)

In a Wednesday letter sent to the Drug Enforcement Administration, Kentucky Gov. Andy Beshear said he supports reclassifying marijuana from a Schedule I controlled substance to Schedule III.?

That would move marijuana from a DEA designation that says it has “no currently accepted medical use and a high potential for abuse” to having “a moderate to low potential for physical and psychological dependence.”?

Easing federal marijuana rules: There’s still a long way to go

Marijuana has been classified as a Schedule I drug since 1970, when Congress enacted the Controlled Substances Act, according to the U.S. Department of Justice.?

Beshear’s letter comes near the end of public comment on a Biden administration proposal to reclassify marijuana. The common period ends July 22. So far the proposal has generated almost 32,000 comments.?

Beshear’s letter also comes as Kentucky is accepting applications for cannabis business licenses ahead of a 2025 legalization for medical marijuana. Medical providers can also apply to Kentucky’s Board of Medical Licensure and Board of Nursing for permission to write cannabis prescriptions beginning next year.?

The bipartisan House Bill 829 that became law during this year’s legislative session moved up the medical cannabis timeline from January 2025 to July 1, 2024.?

Under this law, qualifying patients with a history of post traumatic stress disorder (PTSD), cancer or other approved medical conditions will be able to use marijuana to treat their chronic illnesses.?

“The jury is no longer out on marijuana: It has medical uses and is currently being used for medical purposes,” Beshear wrote. “The recognition is overwhelming – and bipartisan. In Kentucky, for example, I signed a medical marijuana law that passed with support from Republican legislative supermajorities and a Democratic Governor.”

The U.S. Department of Health and Human Services recommended the classification change a year ago. In May, the U.S. Department of Justice announced the Attorney General would “initiate the rulemaking process to transfer marijuana to schedule III.”?

Kentucky Attorney General Russell Coleman’s office did not yet respond to a Lantern inquiry into where Coleman stands on the proposed change.

Lawyers for the state on Monday defended the legislature's decision to outlaw some vaping products. The Kentucky Vaping Retailers Association and the Kentucky Hemp Association are challenging the law. The hearing was held in the Franklin County Court House. (Kentucky Lantern photo by Sarah Ladd)

FRANKFORT — Franklin Circuit Judge Thomas Wingate heard arguments Monday in a case challenging the constitutionality of a 2024 law banning the sale of some vaping products.?

This comes as the defendants — Allyson Taylor, commissioner of the Kentucky Department of Alcoholic Beverage Control, and Secretary of State Michael Adams — filed a motion to dismiss the case.?

Should Wingate grant that motion, the plaintiffs — the Kentucky Vaping Retailers Association, the Kentucky Hemp Association and four vape shops — will appeal the decision, their lawyer told the Lantern. The plaintiffs have also filed a motion for judgment.?

Either way, the case is far from settled. It’s unclear when a decision could come, as Wingate said it will “take a while” for him to review.?

Kentucky’s new anti-vaping law ignites constitutional challenge

The arguments?

The lawsuit centers around House Bill 11, which passed during the 2024 legislative session. Backers of the legislation said it’s a way to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration (FDA).?

Opponents have said it will hurt small businesses and lead to a monopoly for big retailers.?

Altria, the parent company of tobacco giant Phillip Morris, lobbied for the Kentucky bill, according to Legislative Ethics Commission records. Based in Richmond, Virginia, the company is pushing similar bills in other states. Altria, which has moved aggressively into e-cigarette sales, markets multiple vaping products that have FDA approval.?

Greg Troutman, a lawyer for the Kentucky Smoke Free Association, which represents vape retailers, told the judge Monday that, among his issues with the new law, is the way it defines “vapor products” and “other substances,” looping e-cigarettes and vapable hemp and marijuana products together. He argues that combination makes the law too broad and arbitrary to pass constitutional muster.

Troutman argued that because of this, the title of the bill, “AN ACT relating to nicotine products,” didn’t fairly represent the content of the legislation.?

Lindsey Keiser, an assistant attorney general, countered that the title doesn’t need to fully cover the content of the bill.?

“It’s long settled that the title does not need to have a detailed index of everything that’s contained within the bill,” she told the judge.?

Keiser also argued that “the fact that the FDA has approved so few indicates that there is a lot of concern about these products.”

“So,” she said, “it’s reasonable then for Kentucky to … say that ‘if the FDA is only approving this limited number, we too will only approve this limited number.’”??

Later this year, the U.S.? Supreme Court will decide whether or not the FDA was unfair in its denial of at least a million vaping product applications, the Associated Press reported in early July.?

Troutman, arguing for the vape retailers, said the state law is flawed because it’s based on a flawed federal process. “We’ve got a state process that is predicated before a federal process that itself has been deemed arbitrary by at least two federal courts,” he said.?

Meanwhile, HB 11 is set to be enforceable starting Jan. 1, 2025, the same day patients with a history of post traumatic stress disorder (PTSD), cancer or other approved medical conditions — will be able to apply for cannabis cards for medical marijuana.?

Naloxone (Narcan) nasal spray can reverse the effects of opioid overdoses. (Photo by Drew Angerer/Getty Images)

The Kentucky Opioid Abatement Advisory Commission, tasked with distributing opioid settlement dollars, has new members, Attorney General Russell Coleman’s office announced Tuesday. ?

The commission was created by the state legislature in 2021 and has nine voting and two non-voting members.?

Kentucky receives installments toward $900 million in settlements with opioid manufacturers and distributors. So far, it has awarded 110 grants worth more than $55 million toward treatment, prevention and recovery efforts.??

The commission’s new and re-appointed members are:?

• State Rep. Chris Fugate, R-Chavies, who will serve as a non-voting member. He was appointed by Speaker of the House David Osborne.?
• Karen Kelly, chief of staff to U.S. Rep. Hal Rogers, who will serve as a non-voting member. She was appointed by Kentucky Senate President Robert Stivers, R-Manchester.??
• Jason Roop, an assistant professor of business and theology at Campbellsville University. Roop was appointed by the attorney general. He will “represent victims of the opioid crisis,” the AG’s office said, and serve until 2026.?
• Van Ingram, the executive director for the Kentucky Office of Drug Control Policy, was first appointed to the commission in 2022. He will now serve until 2026.
• Patricia Freeman, a professor in the University of Kentucky’s College of Pharmacy, who was appointed by the university from the HEALing Communities study. She will now serve until 2026.?

Chris Evans is the executive director of the commission. Other members are:

• State Treasurer Mark Metcalf
• Cabinet for Health and Family Services Secretary Eric Friedlander
• Von Purdy, the vice president for Advancement and Community Engagement at Simmons College
• Darren “Foot” Allen, a retired Kentucky State Trooper
• ?Karen Butcher, who represents the opioid victim community.?

“As a person in long-term recovery, I take very seriously the responsibility to help ensure more people have access to innovative, transformative and life-saving treatment modalities,” Jason Roop said in a statement. “The recovery journey doesn’t end when treatment is completed, and establishing and maintaining a recovery-friendly ecosystem in our communities remains paramount to our continued success for many years to come.”?

Overdose deaths decreased in Kentucky in 2023 for the second year in a row, though 1,984 still died. That’s down from 2,135 in 2022.?

Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those 2023 deaths — about 79%. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

Despite the overall decrease, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.?

Ingram, the executive director for the Kentucky Office of Drug Control Policy, said this is “a lot more work left to do” on prevention efforts. “We will keep supporting addiction treatment programs until every Kentuckian is saved and has found recovery.”?

The commission will next meet on July 29.?

Tim Robinson, CEO of Kentucky's largest substance treatment provider, photographed June 27 at Addiction Recovery Care's headquarters in Louisa. (Kentucky Lantern photo by Matthew Mueller)

LOUISA — Around the office at Addiction Recovery Care, or ARC, Vanessa Keeton is still known as “Client One” — marking her status as the first client of the first recovery center the organization opened as a group home in Lawrence County.

But her official title is vice president of marketing for ARC, where she has worked since 2012, a little more than a year after she entered the program known as Karen’s House — choosing it over jail for a string of drug and alcohol-related offenses.

“Dec. 2, 2010, that was my first day,” she said. “That’s a day I’ll never forget as long as I live. That’s the day that everything changed.”

ARC, too, has changed dramatically since it started as a treatment home for women run by volunteers, based largely on Bible study and prayer.

It now operates as a for-profit company paid $130 million last year by Medicaid, ?the government health plan which in 2014 expanded access to addiction treatment, or substance use disorder, as it’s now known.

Gov. Andy Beshear has praised ARC for helping Kentucky — ravaged in recent years by addiction and overdose deaths — become the state with the most treatment beds per resident in the nation, according to an East Tennessee State University study.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at an ARC ribbon-cutting for a new facility in March.

Owned by founder and CEO Tim Robinson and his wife, Lelia, the company provides the couple an annual income of about $533,400, according to a 2022 tax-filing by Odyssey Inc, a non-profit affiliated with ARC.

Robinson said he and his wife struggled financially for years while establishing the treatment business — facing potential foreclosure on their home and repossession of their car. He doesn’t think that income is unreasonable.?

“We took a lot of risks,” said Robinson, 48, a lawyer and recovered alcoholic who has been sober since 2006 — two years before he started building the faith-based treatment business that would become ARC. “I’m living the American dream. I’m doing better than I ever thought I could be doing financially.”

Kentucky’s largest provider

The fast-growing company is by far the state’s largest substance treatment provider, with 1,800 residential beds in 24 Kentucky counties, and reaches hundreds more clients through outpatient services. ARC, which estimates it provides 75% of treatment beds in Kentucky, also is planning programs in Ohio and Virginia.

Earlier this year, ARC opened a 40-bed behavioral health unit with plans to expand to 300 at the former Our Lady of Bellefonte Hospital in Ashland, which closed in 2020. In 2020, ARC opened its largest center — with a capacity for 700 — on the campus of St. Catharine College in Springfield, which closed in 2016.

ARC is no longer simply a treatment organization, said Matt Brown, a former ARC client who overcame addiction and now serves as ARC’s chief administrative officer and president of ARC Healthcare.

“We view ourselves as a behavioral health system,” Brown said.

While Christian faith remains at the heart of its mission, ARC relies on professional therapists, medical specialists including nurses and doctors, a structured treatment program and medication such as Suboxone to reduce the cravings of some patients for drugs and help them maintain sobriety, Robinson said.

Its religious component — which includes tracking how many clients decide “to follow Christ” (1,320 in 2023) — is strictly voluntary, according to Robinson, who said he was able to get sober in 2006 with the help of a local pastor and friend who “led me to the Lord.”?

More importantly, he said, is that the number of clients who agree to stay in long-term treatment up to six months has increased steadily, which he thinks is the best indicator of effectiveness of the program.

Medicaid, which funds the majority of substance treatment, doesn’t require programs to measure outcomes.

But ARC measures its own outcomes, which it reports to Medicaid quarterly, Robinson said. That includes a retention rate of around 70% of its clients in treatment for up to six months and even longer through periodic contact with a case manager.

“I’ve been in this a long time,” Robinson said. “Long-term residential treatment is the reason people recover.”

As an indicator of success in addressing addiction, the Beshear administration points to the decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

But Beshear said the fight must continue.

“We recognize that even while we celebrate progress, there’s a lot of heartbreak and pain because of this epidemic that continues,” Beshear said.

Last year, ARC received about $130 million in payments from Kentucky’s Medicaid program — more than double the amount of its closest competitor, Spero Health, a Nashville- based company that received $60 million in Medicaid funds in 2023, according to the Cabinet for Health and Family Services, which licenses and oversees treatment facilities.

ARC accepts private insurance, but Robinson and Brown said that almost all of the company’s revenue is from Medicaid since their clients generally have lost jobs and any health insurance because of addiction.

Overall, the state spent $1.2 billion on substance use disorder services in fiscal year 2023, with the majority of funds coming from the federal government, according to the cabinet.

Robinson, a former county prosecutor who started his business from a home office in Louisa, has emerged as a major political donor and well-connected business leader, last year appointed to the Kentucky Chamber of Commerce board.

Beshear singled out Robinson for recognition in his State of the Commonwealth speech in January, calling him “an essential partner in our fight against addiction.”

Robinson, a lifelong Republican, is effusive in praise for Beshear, a Democrat, in part because of the governor’s emphasis on addiction treatment and the governor’s frequent references to his own religious faith.

“I’ve never been for anybody like I’ve been for Andy Beshear,” Robinson said. “I hope he runs for president.”

‘Treatment on demand’

ARC employs 1,350 people with 500 based at its headquarters in tiny Louisa (population 2,600) perched on the edge of the Big Sandy River next to West Virginia. The company is Lawrence County’s largest employer, ahead of the school system and local hospital.

About 40% of its workers are “graduates” of its treatment program, Robinson said, and most of its upper management — himself included — are in recovery from addiction.

ARC promises “treatment on demand,” and operates a 24-hour hotline people can call to identify help within 15 minutes, including transportation, if needed, to one of its centers. Last year it served more than 12,000 individuals from 119 of Kentucky’s 120 counties.

It has developed a network of job-training programs including welding, automotive repair, lawn service, culinary arts, chaplaincy and food service. As part of that, ARC has rebuilt more than a block of rundown buildings in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space.

It offers clients a chance to get certification toward a trade and get college credit for some training.

ARC owns a pharmacy used to provide medication to clients, a laboratory for medical testing and operates a health clinic in Louisa. Also, Tim and Lelia Robinson founded the private Millard School, a Christian academy in Louisa attended by some children of their employees.

Vanessa Keeton’s husband, James Keeton, a 2011 ARC graduate, manages the Second Chance garage which repairs and restores autos for the public as well as maintaining an ARC fleet of about 200 vehicles.

“We restore cars and we restore lives,” he said.

The Keetons live in Louisa and their son attends the Millard School.

And ARC runs a sophisticated marketing program complete with a website, billboards, television and radio commercials, a social media presence, sponsorships and news releases, contracting with the Louisville-based public relations firm, RunSwitch. Scott Jennings, CNN commentator and Republican political consultant, is one of RunSwitch’s founding partners. ARC spends about 4.5% of its revenue, or about $5.8 million a year on marketing.

Vanessa Keeton said the marketing is important to promote awareness of its services to those in need, “to meet people where you are.”

‘Buying influence?’

Some outsiders criticize ARC for its rapid growth, its size and Robinson’s political giving, including Mark La Palme, the founder and former CEO of Isaiah House, a treatment program based in Harrodsburg.

La Palme, now retired, said he worked with Robinson on a project in the mid-2000s but parted ways over disagreement with practices including designating clients as “interns” in ARC programs for low pay while in treatment, saving the company the cost of paying a regular employee.

He calls ARC “huge,” has called it a “bully” in a social media post and questions its rapid expansion. La Palme also questions the prolific giving of Robinson and ARC entities, which rank among the state’s major political contributors.

“It seems like you’re buying political influence,” he said.

But he allows Robinson has been highly effective in building ARC into the state’s largest treatment system.

“He’s dangerously brilliant,” he said.

Robinson considered La Palme a friend and colleague but said they parted ways after a proposed collaboration fell through. Robinson said ARC’s programs meet all state standards, are accredited and the company works to provide high quality care.

He said internships are a way of introducing people to job skills they will need to succeed once they leave treatment and interns in various job training programs receive a paycheck either through ARC or an outside employer.

Robinson said he doesn’t apologize for political giving, seeing it as a way to support causes and politicians he believes in.

And he doesn’t think ARC is too big, saying that the company had to expand to remain viable within the constraints of Medicaid reimbursement, which pays for most of its clients.

“We had to grow to survive,” he said.

Robinson’s employees who spoke with Kentucky Lantern, including Brown, are highly enthusiastic about the boss.

Brown, trained as a physical therapist, battled addiction for 18 years before coming to ARC as a patient and remaining as an employee.

Robinson is “a visionary,” Brown said during a tour of ARC properties in Louisa, “He sees things in people before they see it in themselves.”

‘Papaw taught me’

Robinson said he grew up next door to Louisa in Martin County, his home in “the poorest part” of a poor county.

His introduction to business came from his grandfather who owned a country store.

“He put me on a pop carton to run the cash register,” he said. “Papaw taught me about business.”

Another boyhood business venture of Robinson’s — selling baseball cards — would provide a life-changing entrée into college and law school, when he was befriended by Inez banker and businessman Mike Duncan, a power player in Republican party politics and former chairman of the Republican National Committee.

Robinson said he and Duncan crossed paths when he began selling baseball cards to his young son, Robert M. “Rob”? Duncan, who also would become a lawyer and, under former President Donald Trump, was appointed U.S. Attorney for the Eastern District of Kentucky.

Rob Duncan now serves as the top deputy to Kentucky Attorney General Russell Coleman.

Robinson considers both the father and son friends but said he remains closest to Mike Duncan, a trusted friend and adviser.

Mike Duncan, Robinson said, showed interest in his boyhood baseball card venture and became a mentor, encouraging Robinson to go to college — a prospect he hadn’t considered.

“Nobody in my family ever went to college,” Robinson said.

But with Duncan’s encouragement, Robinson graduated from the University of the Cumberlands in Williamsburg, earned a law degree from the University of Kentucky and was elected student body president at both institutions.

Good times and bad times

“He helped me through the good times and the bad times,” Robinson said.

Among the worst times: Robinson’s 2003 indictment for felony vote fraud while he was student body president at UK, after some 750 voter registration cards collected during a student government drive were never turned in. Apparently forgotten, they were later found in a student government office, according to a 2003 Lexington Herald Leader story.

“It was devastating,” Robinson said. “I thought my whole life was over.”

Instead, with the help of his lawyers, Robinson pleaded guilty to a lesser misdemeanor charge of failing to turn in the registration cards and paid $90 in restitution. Robinson said he dropped out of law school during the legal case, but was readmitted and graduated.

But that ordeal, plus the death of his mother while he was at UK, “finished my mental health off,” Robinson said.

He returned home to Eastern Kentucky to work but alcohol by then had a powerful hold on his life.

‘A raging alcoholic’

Back in Lawrence County, Robinson joined in law practice with a friend and became an assistant county attorney but by then said he had become a “raging alcoholic” though still somehow able to perform his job.

He would drink on weekends, come to work on Mondays hung over and avoid alcohol on days he had to be in court. Toward the end of the week, Robinson said, he’d resume drinking and stay drunk till the following Monday.

“I was leading kind of a double life,” he said.

That continued until a deputy sheriff at the courthouse where Robinson worked intervened. The deputy, also a pastor and a recovering alcoholic, helped Robinson stop drinking through prayer and support — taking him with him to nightly events where he would preach and play Bluegrass music.

Though Robinson said he knew nothing about treatment or programs such as Alcoholics Anonymous, he decided he needed to expand services in the region that in the mid-2000s offered little.

“I was convinced God was calling me to stop practicing law and start a recovery center,” Robinson said.

So he did, leaving his law job and starting out of a home office on Nov. 3, 2008.

Robinson got help from? Rev. Ralph Beiting, a Catholic priest who founded the Christian Appalachian Project based in Paintsville and together they opened a recovery house for women in Lawrence County called Karen’s House.

It was a makeshift operation run by volunteers with donated goods, including some old Army cots. Meanwhile, Robinson was taking men to the closest treatment center, Chad’s Hope in Clay County, getting occasional funding from Operation UNITE, launched in 2003 by U.S. Rep. Hal Rogers to help Kentucky battle rising addiction — in particular the tide of opioid pain pills engulfing the state.

But broke and discouraged, Robinson was close to quitting when he contacted a consultant who suggested he expand by opening a second recovery center for men. He located a site in Fleming County and in 2013, Belle Grove Springs was opened by the company that would become ARC.

Brown, now ARC’s chief administrative officer, was among the first clients admitted to the men’s center.

The following year, under the Medicaid expansion authorized by the Affordable Care Act, the government health plan began funding substance use disorder services and a reliable funding stream opened. Kentucky was among the first states to include addiction as a service covered by Medicaid.

While the income was welcome, it wasn’t enough to finance ARC’s operation and Robinson said the company’s only choice was to expand and recoup more money through a higher volume of clients.

“People thought we were growing because we were booming but we had to grow to survive,” he said. “You cannot make it on a couple of small facilities.”

ARC didn’t show a positive cash flow until 2019, he said.

‘Take our time’

While ARC expansion has slowed, Robinson said the company is still looking at other opportunities, including expansion into Virginia, which has far fewer treatment beds than Kentucky.

“We’re going to take our time,” he said.

ARC also was flagged in a budget item this year by the state General Assembly with a $12 million allocation over two years directed to the Life Learning Center in Covington, an organization aimed at helping people develop skills to improve their lives “through gainful employment.”

The budget line says the funds are to be distributed to the center to support “treatment, rehabilitation, and community reintegration in partnership with Odyssey Inc.”

Odyssey is the non-profit arm affiliated with ARC.

Robinson said he expects Odyssey to submit a proposal as treatment provider for a program the center plans to establish in Somerset.

And while his work has expanded statewide and beyond, Robinson said he’s committed to staying in Louisa and keeping his company headquartered there.?

“I’m where I’m going to be,” he said. “This is my adopted hometown.”

Syringe exchanges provide intravenous drug users with clean needles to prevent the spread of bloodborne diseases like HIV and hepatitis. (Getty Images)

Attorney General Russell Coleman issued details Thursday of more than $12 million in grants from the state’s opioid settlements for prevention, enforcement, treatment and recovery.

One of the grants will expand a syringe exchange, and was not supported by Coleman’s appointees to the commission. He confirmed at an event Thursday that he opposes the exchanges.

“I’m extremely concerned that needle exchange further perpetuates drug use, and it will not be supported by me or this administration,” he said in response to questions at an event he held to highlight the grants.

Coleman said the 51 grant recipients, chosen from 160 applicants, represent “bold ideas” aimed at trying to “save lives and tackle this crisis,” with a focus on the three-legged stool of prevention, treatment and enforcement.

“We’re building programs and services that help Kentuckians for the next generation,” he said.

The announcement was made at DV8 Kitchens in Lexington, which employs people in recovery and is getting a $151,730 prevention grant to establish an employee-success mentorship program.?

“By connecting those in recovery with meaningful employment, we can give them a second chance at success,” DV8 owner Rob Perez said in a news release from Coleman’s office.?

At the event, Perez stressed that while DV8 is “for people,” its success is also good for the community. “Every time one person doesn’t return back to addiction, we saved $37,000 as a community,” he said.?

Coleman’s office oversees the Kentucky Opioid Abatement Advisory Commission, which the legislature created in 2021 to distribute the state’s portion of the $900 million in settlements with opioid manufacturers and distributors. The money is being paid in installments. The commission has awarded $55 million in 110 grants, including $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in 11 pilot counties.?

Coleman said it’s important to remember where this settlement money comes from. “This is blood money, purchased by pain and devastation of families across this commonwealth, which is why we must be such stewards of this money,” Coleman said. “We’re honoring those we’ve lost by our stewardship and how we use this money effectively.”?

Half of the settlement money goes to the state and the other half goes to cities and counties. The commission is housed in the attorney general’s office and is headed by Chris Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Syringe exchanges

Evans was one of the Coleman appointees who did not support a grant to the Boyle County Agency for Substance Abuse Prevention at the June 4 commission meeting. In passing on the vote, he revealed Coleman’s position on syringe exchanges.

The grant was approved by a majority vote. Coleman took office in January and has not yet made all of his five appointments; those members serve two-year terms. The other voting members are appointed by the University of Kentucky or serve by virtue of their office, including Coleman, who has designated Evans to hold his seat.

Two of the five positions that are appointed by Coleman were reappointed in June 2023, before he took office, with their terms expiring June 30, 2025. They included Karen Butcher and Von Purdy, both representing citizens at-large. Coleman appointed Darren “Foot” Allen, representing law enforcement, in February and that term will expire June 30, 2025. The other two positions to be appointed by Coleman expire at the end of this month. At this time Van Ingram, representing the drug treatment and prevention community, and Jason Roop, representing victims of the opioid crisis, fill those positions.

Asked if Coleman will make decisions about future appointments to the commission dependent on the person’s view of syringe exchange programs, spokesperson Kevin Grout answered “No” in bold letters in an email.

Kentucky Health News asked Coleman if his lack of support for syringe exchanges for intravenous drug users, which are supported by research, could put a chilling effect on future applications for these programs.

He replied, “There’s been no grant that has been blocked because of my personal opposition.” He went on to say, “I don’t support needle exchange. I support very robustly prevention, treatment and enforcement.”

Asked if he had research to support his opinion, he said, “I’m a strong proponent of Narcan [an anti-overdose drug] and I’m a strong proponent of prevention. I’m very concerned that particularly when there’s not a one-to-one ratio, a one-to-one return on needles that it is an enabler versus the harm reduction that we’re actually seeking.”

Some syringe exchanges have a one-for-one requirement, but regional health official Scott Lockard said in 2016 that most exchanges at that time used a “patient negotiation model,” giving the user as many needles as they need for one week to assure they use a clean needle each time, often up to a capped number.

“The goal is that they use a clean needle for each time they inject,” Lockard said then. He said it is impossible to adhere to a strict one-for-one requirement. For example, he said users don’t always keep up with their syringes or sometimes will tell you they are sharing them.

Coleman said he is a very strong advocate for wide distribution of Narcan, “given the nature of the threat we’re seeing. … Narcan needs to be as ubiquitous as a fire extinguisher given this threat. But it always has to be Narcan plus a pathway to treatment, Narcan plus education. Because Narcan itself can be an enabler in some contexts. We want to make sure it’s always coupled with treatment, coupled with prevention.”?

Coleman also talked about his plans to build a statewide drug prevention program, with a goal of rolling it out this next school year.?

“We exist in a commonwealth where as little as one pill can and is taking our sons and our daughters,” he said. “But yet we lack a statewide prevention effort in our commonwealth. That will change.”

Coleman’s office declined to release details of the grants until Thursday’s event.

Here’s a summary of how the 23 new prevention grants will be used:?

Anderson County Agency for Substance Abuse Prevention, $171,100 for expansion of school-based prevention efforts and law-enforcement training.

Appalachian Research & Defense Fund (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.

Big Brothers Big Sisters of the Bluegrass, $185,301 for a high-school mentoring program, to empower high school students to become positive role models for younger students.

Boys and girls Clubs of Kentuckiana, $200,000 for an innovative program aimed at opioid prevention for youth aged 6-18.

Carter County Public Library, $101,500 to hire resource specialists to prtovide greater access to recovery-oriented programming.

Covington Partners, $225,450 for prevention programming that includes out-of-school-time programs, school-based health services, mentoring, drug and violence prevention and family engagement.

Cumberland Trace Legal Services (Legal Aid), $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.

DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730 for the mentorship program, which will focus on removing barriers, supporting career-path development and job readiness while supporting recovery and wellness.

Girl Scouts of Kentucky Wilderness Road Council, $59,052 to launch the Building the Bridge to K-12 Girls Leadership Project, a community-based prevention program that focuses on increasing girls’ positive childhood experiences.

Jewish Family and Career Services, Louisville, $77,207 for enhancement of wraparound services for youth, to include opioid addiction screening and active prevention.

Legal Aid Society, $125,000 for legal support and wraparound services that help stabilize people in recovery by addressing employment barriers and other destabilizing civil legal issues.

Legal Aid of the Bluegrass, $125,000, same as above.

Mercy Health – Lourdes Hospital, $76,552 for a hospital-based, pharmacy-led tapering program, which slowly resudes doses of a drug over time to reduce withdrawal symptoms.

Operation Parent, $87,011 for prevention education of parents of 4th, 6th and 9th grade students in several Kentucky counties.

The Safety Blitz Foundation, $126,335 for a pilot version of The Coaches vs. Overdoses program, which addresses youth opioid misuse, the proliferation of synthetic opioids including illicit fentanyl, through prevention, education, awareness and community drug-disposal programming.

Scott County Sheriff’s Office, $91,847 for Drug Abuse Resistance Education in 5th and 9th grades.

Taylor County Schools, $208,824 for a school-based prevention program.

Three Rivers District Health Department, Owenton, $320,803 for a partnership with the Planet Youth program to implement a population-wide primary prevention process designed to take informed actions to increase protective factors, decrease risk factors and ultimately change the environment of children and youth.

University of Kentucky Research Foundation, $380,572 for development of prevention coalitions in Fayette County, educating 4th through 12th grade students and building community capacity and engagement around prevention efforts.

Operation UNITE, $751,850, for continuation and expansion of its Educate. Empower. Prevent. Program, which provides prevention training to students from 4th through 12th grades.

Wanda Joyce Robinson Foundation, Frankfort, $90,472 to start a youth substance intervention and prevention program that prevents substance use and abuse and promotes positive youth development and stronger families. The foundation helps children with incarcerated parents.

WestCare Kentucky, $100,404 for Camp Morilla, a free addiction prevention and mentoring day camp program for youth ages 9-12 and their families who have been impacted by family opioid use.

Young Men’s Christian Association of Greater Louisville, $248,487 for the YNOW Mentoring Program, which focuses on helping youth develop healthy drug-and violence-free lives.

Here is a summary of how the 28 new treatment and recovery grants will be used:?

Appalachia Regional Healthcare, $94,572 for expanding its peer recovery team so peer recovery coaches can be placed in four more hospitals.

Backroads of Appalachia, $167,025 for women in recovery with workforce training and employment opportunities.

Boyle County ASAP, $282,610 for expansion of its harm reduction program (including a syringe exchange), resilient-kids programming and case management efforts.

Celebrate Recovery Fairdale, $30,004 for weekly recovery meetings.

Center for Employment Opportunities, $255,109 for expansion of employment services for justice-impacted individuals in treatment or recovery.

Chrysalis House, Lexington, $227,273 for treatment for pregnant and parenting women.

Comprehend, Inc., $426,087 for opening a buprenorphine clinic in a community mental health center.

Eastern Kentucky Concentrated Employment Program, $450,000 for career and support services for people who are in recovery and comorbid polysubstance use who are interested in entering or re-entering the workforce.

Family Nurturing Center of Kentucky, $221,937 for services to children impacted by their caregiver’s opioid use and provides needed support to parents in recovery.

Family Scholar House, $245,110 for a five-step approach revolving around wrap-around services during and post-treatment to progress individuals from ‘crisis to stability’ targeting single parents, foster alumni, individuals facing reentry and post-secondary students.

Grin Grant, Lexington, $361,251 for expansion of dental restoration scholarships and peer support services and launch of a new recovery program.

Hope Center, $680,280 for in-patient, residential treatment for men.

Hope Springs Church, $50,462,Supports regular recovery support meetings and events.

Horsesensings, Inc., Bagdad, $115,219 for therapeutic job training in the horse industry and housing for those in recovery.

Isaiah House, $250,000 for recovery housing and job training aftercare opportunities for those in long-term recovery.

Kentucky Hospital Research and Education Foundation (Ky. Hospital Assn.), $250,000,Supports expansion of a program that ensures patients have 24/7 access to care.

Lake Cumberland Area Development District, $277,552 for case management and supportive services to individuals in recovery seeking to re-enter the workforce.

Life Learning Center, Covington, $498,500 for “a cutting-edge, technology-enhanced system designed to fill existing gaps in recovery services by providing continuous, real-time data, support and accountability.”

Mercy Health-Marcum and Wallace Hospital, Irvine, $179,834 for recovery services for individuals with criminal justice involvement.

Natalie’s Sisters, $88,356 for expansion of services for women who have been sexually exploited or trafficked.

Northeast Kentucky Regional Health Information Organization, $331,997 for the Career Ready Workforce Project, which will focus prevention efforts on high-school students preparing to enter the workforce, individuals struggling with addiction ,and local agency staff members seeking to increase employable skills.

Ramey-Estep Homes, Rush, $222,801 for teen prevention-education programming, expansion of first-responder trauma-treatment programming and expansion of treatment and recovery access.

Recovery Café Lexington, $276,278 for expansion of recovery support model to a third location in Frankfort.

Transitions, Inc., Covington, $156,000 for expansion and enhancement of treatment services, as well as expansion of community education and prevention activities in the African American community.

Voices of Hope-Lexington, $538,021 to increase the quantity and quality of recovery support services for people in or seeking recovery.

Volunteers of America Mid-States, $664,587, for two recovery community centers in Lincoln and Pulaski counties.

Four Rivers Behavioral Health, Paducah, $232,251 for a mobile recovery support vehicle program that provides services to adults.

Young People in Recovery, Louisville, $301,440 for peer-led chapter and life-skills curriculum programs for people seeking recovery and a youth prevention program for middle- and high-school-aged children and their parents in five communities.

This story has been updated with information from Kevin Grout, spokesman for Attorney General Coleman.

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Used syringes are ready for safe disposal at a needle exchange clinic where users can pick up new syringes and other clean items for those dependent on illegal injectable drugs, Feb. 6, 2014 in St. Johnsbury, Vermont. (Photo by Spencer Platt/Getty Images)

The leader of the agency that makes grants from the state’s opioid settlements declined to support funding for a syringe-exchange program, saying Attorney General Russell Coleman does not support such programs — which are considered a key tool for reducing harm to people who inject drugs.

Kentucky Opioid Abatement Advisory Commission Director Chris Evans, who works for Coleman, passed on a June 4 vote that approved a grant to the Boyle County Agency for Substance Abuse Prevention, one of 119 such county agencies.

“This application does increase outreach, which includes educational training, Narcan distribution and referrals to treatment,” Evans said. “However, the request does increase the funding of the syringe-service position, which the Office of the Attorney General does not support syringe exchange programs. So I will be passing on the vote of this application.”

Asked later why Coleman opposes syringe-exchange programs, Coleman spokesman Kevin Grout said in an email, “Attorney General Coleman is committed to supporting effective prevention, treatment and enforcement efforts. He strongly supports the distribution of Naloxone and other overdose reversal drugs. However, he cannot support syringe-exchange programs, which he believes enable drug use without effectively promoting recovery.”

Elected in November, Coleman, a Republican, is a former FBI agent and former U.S. attorney under President Donald Trump.

Syringe exchanges are supported by research. The U.S. Centers for Disease Control and Prevention says injection drug users who have access to syringe exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

The exchanges were authorized by the state’s 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. As of March 14, the state had 80 operational syringe exchange programs in 65 counties.

Later voting against the grant request because of their opposition to syringe exchange programs were commission members state Treasurer Mark Metcalf and retired Master State Trooper Darren “Foot” Allen, whom Coleman appointed to fill a slot representing law enforcement. Allen said, “There’s some people that I trust that tell me this is okay. However, I’m just not in favor of needle exchange. I suspect that this time next year, I won’t change my position but I am open to looking at that option,” he said.

Despite the opposition, Boyle County’s ASAP grant request for $282,610 passed with a 6-2 majority vote. The commission is comprised of nine voting and two non-voting members from the legislature.

Third round of grants approved

The Boyle County grant was the only one put up for a vote that had any opposition at the commission’s June 4 meeting. In all, the commission members approved 51 organizations to receive just over $12 million in grant money.

The legislature created the commission to distribute the state’s portion of the approximately $900 million in settlements with opioid manufacturers and distributors, half of which goes to the state and the other half goes to cities and counties. The commission is housed in the attorney general’s office and is headed by Evans, a former chief operating officer for the U.S. Drug Enforcement Administration.

Of the $12 million in this round of grant money, 28 of the awards were given for treatment and recovery, and 23 were given for prevention. This is the third round of state grants, with $32 million awarded to 59 groups in the first round and $13.9 million awarded to 34 groups in the second round.

Asked for brief details of each grant, Grout said they would be announced next Thursday at a press conference at DV8 Kitchen-East End in Lexington, one of the grant recipients.

The 28 new treatment and recovery grants are:

Appalachian Regional Healthcare, $94,572.

Backroads of Appalachia, $167,025.

Boyle County ASAP Board, $282,610.

Celebrate Recovery Fairdale, $30,004.

Center for Employment Opportunities, $255,109.

Chrysalis House, $227,273.

Comprehend Inc., $426,087.

Eastern Kentucky Concentrated Employment Program, $450,000.

Family Nurturing Center of Kentucky, $221,937.

Family Scholar House, $245,110.

Grin Grant, Lexington, $361,251.

Hope Center, Lexington, $680,280.

Hope Springs Church, $50,462.

Horsesensing Inc., $115,219.

Isaiah House, $250,000.

Ky. Hospital Research and Ed. Foundation (Ky. Hospital Assn.), $250,000.

Lake Cumberland Area Development District, $277,552.

Life Learning Center, $498,500.

Mercy Health – Marcum and Wallace Hospital, Irvine, $179,834.

Natalie’s Sisters, $88,356.

Northeast Kentucky Regional Health Information Organization, $331,997.

Ramey-Estep Homes, $222,801.

Recovery Café Lexington, $276,278.

Transitions Inc., $156,000.

Voices of Hope – Lexington, Inc., $538,021.

Volunteers of America Mid-States, $664,587.

Four Rivers Behavioral Health, $232,251.

Young People in Recovery, $301,440.

The 23 new prevention grants are:

Anderson County ASAP, $171,100.

Appalachian Research & Defense Fund (Legal Aid), $125,000.

Big Brothers Big Sisters of the Bluegrass, Inc., $185,301.

Boys and Girls Clubs of Kentuckiana, $200,000.

Carter County Public Library, $101,500.

Covington Partners, $225,450.

Cumberland Trace Legal Services (Legal Aid), $125,000.

DV8 Kitchen Vocational Training Foundation and DV8 Kitchens, $151,730.

Girl Scouts of Kentucky Wilderness Road Council, $59,052.

Jewish Family and Career Services, $77,207.

Legal Aid Society, $125,000.

Legal Aid of the Bluegrass, $125,000.

Mercy Health – Lourdes Hospital, $76,552.

Operation Parent, $87,011.

The Safety Blitz Foundation, $126,335.

Scott County Sheriff’s Office, $91,847.

Taylor County Schools, $208,824.

Three Rivers District Health Department, Owenton, $320,803.

University of Kentucky Research Foundation, $380,572.

Operation UNITE, $751,850.

Wanda Joyce Robinson Foundation, $90,472.

WestCare Kentucky, $100,404.

Young Men’s Christian Association of Greater Louisville, $248,487.

The grant application portal is closed until the commission opens it for the next round of awards.

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

A Narcan vending machine in the exit lobby of the Louisville Metro Department of Corrections. (Kentucky Lantern photo by Sarah Ladd)

Overdose deaths in Kentucky decreased in 2023 for the second year in a row, Gov. Andy Beshear announced Thursday as he released the Drug Overdose Fatality Report.?

In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and fentanyl.?

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

Despite the overall decrease, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.?

“We recognize that even while we celebrate progress, there’s a lot of heartbreak and pain because of this epidemic that continues,” Beshear said.?

Van Ingram, the executive director for the Kentucky Office of Drug Control Policy, said distribution of Narcan, which can reverse opioid overdoses, in the state is key. Local health departments, recovery community centers and regional prevention centers provide free Narcan across the state. Find free Narcan near you here. In 2023, 160,000 doses of Narcan were distributed in Kentucky.?

“Fentanyl is what’s driving this crisis,” Ingram said. “If we can ever get a handle on that, I think the success we can have is unbelievable.”?

In 2023, the legislature decriminalized fentanyl test strips. Check with your local health department to obtain the test strips, which can easily detect the presence of fentanyl in pills and other drugs within moments.?

The fatality report shows the highest rates of fatal drug overdoses were Estill, Lee, Breathitt, Powell and Floyd counties. Fentanyl and meth potency was the highest in Jefferson, Fayette, Kenton, Madison and Pike counties.?

Narcan is an opioid reversal treatment. (Kentucky Lantern photo by Sarah Ladd).

Five sites that distribute naloxone, commonly known as Narcan, received 8,000 new doses this week as part of the state’s settlement with Teva Pharmaceuticals, Attorney General Russell Coleman announced Friday.?

The doses went to sites in Louisville, Florence, Ashland, Paducah and Frankfort.?

Narcan can reverse opioid overdoses. This shipment is the first of four that are required in the settlement terms in addition to the $70+ million the company will pay Kentucky over the next 13 years. Teva will provide Kentucky with a total of 23,000 units of Narcan.?

“Naloxone is a critical lifeline for Kentucky families struggling with addiction,” Coleman said in a statement. “Equipping first responders, health professionals and treatment providers with this all-important medication can help save lives for Kentuckians on the road to recovery.”

Find free doses at FindNaloxoneNowKY.org.

How to use Narcan

Experts recommend people — especially those who are at higher risk of overdosing — keep Narcan on them so they can help reverse an overdose if they come across one.?

A person can’t use Narcan on themselves, but they can share it with their loved ones, who can use it to try to save them in the case of an overdose.?

Signs of an overdose include:?

• Labored breathing or not breathing at all?
• Unresponsiveness?
• Blue or gray lips or nails
• Choking or gurgling sounds?
• Pale or clammy skin?

If you think someone is overdosing, here’s what experts say to do:?

• First, call 911 so help is on the way.
• Try speaking to the person. For example, say: “I believe you might be overdosing, and I am going to administer Narcan.”?
• Take your knuckles and rake them over the person’s chest. This may also elicit a response.?
• If the person isn’t responsive, administer Narcan.?

A box of Narcan comes with user instructions, which include these rescue steps:

• Put the person on their back.?
• Tilt the person’s head back.?
• Insert the Narcan nozzle into one of the person’s nostrils.?
• Press the plunger and then remove the nozzle from the nose.?
• If the person doesn’t respond, in two minutes, repeat the process.?
• Stay with the person until emergency medical staff arrive.?

People wait in line for a methadone clinic to open in Hoquiam, Wash., in 2017. As a chorus of physicians and advocates calls for loosening methadone restrictions, states have been slower to adopt new relaxed federal rules. (David Goldman/The Associated Press)

Matt Haney’s home in San Francisco isn’t far from a methadone clinic.

The 42-year-old state lawmaker has watched people line up early each morning outside the clinic in the Tenderloin, a community long considered the epicenter of the city’s substance use epidemic. His neighbors wait for the daily dose of methadone that relieves their cravings and minimizes opioid withdrawal symptoms.

Despite methadone’s effectiveness, a labyrinth of state and federal rules — meant to guard against its misuse — keeps it inaccessible to many people who desperately need it, Haney said.

“What kind of normal person with a job, a life and a family can line up for medication every morning, sometimes far from where they live?”

The Democratic assemblymember and majority whip noted that California is one of many states with rules that are stricter than federal regulations on when, where and how people can access opioid treatments like methadone.

“It’s almost comical how difficult it is to get this medication and stay on it,” he said.

Yet addiction treatment in the United States is poised for change. This year, the federal Substance Abuse and Mental Health Services Administration, known as SAMHSA, made permanent a set of pandemic-era rules that loosened several restrictions, including those on take-home doses of methadone.

It’s a move that a broad consensus of academics, advocates and providers says will improve treatment access and success rates. Having the flexibility to take medication at home can mean patients can get to work or get their kids to school on time. They can deal with family emergencies and unexpected travel. And they avoid the stigma of waiting in line at a clinic.

In theory, the new federal rules make more take-home methadone doses available to a wider subset of patients. But what’s less clear is how the rules will trickle down to states. There’s concern states that didn’t preserve the relaxed regulations they had during the pandemic might be slow to adopt them now.

“A number of states will have to revise their regulations if they’re going to be in alignment with what SAMHSA has released,” Mark Parrino, founder and president of the American Association for the Treatment of Opioid Dependence Inc., a national trade group that supports the new federal regulations. “What could delay implementation would be the state regulators.”

Later this month at his group’s annual conference, SAMHSA will convene a closed-door meeting of regulators from all 50 states to discuss the new federal rules and how states might bring their own standards into compliance, Parrino said.

It’s all happening as the opioid crisis, driven by rising fentanyl overdoses, has prompted a chorus of physicians and advocates to call for loosening methadone restrictions even further — a move that leaders at many opioid treatment programs oppose.

‘Liquid handcuffs’

Medications that treat opioid use disorder — such as methadone, buprenorphine and naltrexone — are rigorously regulated by the government. They block the effects of opioids or halt withdrawal symptoms and reduce cravings without causing the same feelings of euphoria.

But while medications like buprenorphine can be prescribed by a physician and taken at home, methadone can only be prescribed and dispensed in the United States through federally certified clinics called opioid treatment programs. Methadone can be taken as a liquid, a pill or an injectable.

Currently, about 1,800 certified opioid treatment programs operate in the United States, giving methadone treatment to about 400,000 people.

That’s just 19% of the estimated 2.1 million people in the United States who have opioid use disorder.

As Fentanyl Use Spikes, Feds Urge States to Ease Methadone Rules

Until the pandemic, most methadone patients had to visit a clinic daily to take their doses while a provider watched. Restrictions stem from concern that methadone can be abused or resold. Even though it does not produce an intense high, it’s possible to overdose if it’s not taken as prescribed.

But the tight regulation created a system that keeps patients tethered to the nearest methadone clinic with what some have called “liquid handcuffs.” Long clinic lines, varying hours, counseling requirements and inflexible rules around rescheduling appointments make it difficult for patients to juggle job and family responsibilities.

One pregnant patient in a 2021 study reported being required to remain in line at her methadone clinic even after her water broke. Other patients said they were refused take-home doses for family emergency situations or were randomly required to make additional clinic visits. Ten states require methadone providers to observe patients during urine sample collection, according to a 2021 analysis by The Pew Charitable Trusts.

“There’s no other medical condition where we feel like patients need to earn the right to treatment,” said Ximena Levander, an addiction medicine physician and researcher at Oregon Health & Science University. “What SAMHSA has done with these new rules is to try to shift that paradigm from a punitive, ‘you need to earn this’ model to a patient-centered, individualized treatment plan.

“But it’s going to take time for that culture change to happen.”

A power imbalance

At the outset of the COVID-19 pandemic, federal officials allowed states to give more methadone patients up to 28 days of take-home doses. In February of this year, SAMHSA made these new, looser rules permanent. They went into effect last month, and opioid treatment programs have until October to comply.

“That’s an ambitious timeline,” said Parrino, of the trade group. His association represents more than 1,300 opioid treatment clinics.

At least 10 states had “stability criteria” for take-home doses that were stricter than federal rules as of June 2021. Individual opioid treatment programs might be more conservative still. Some, for example, won’t allow take-home doses for patients who drink alcohol or use cannabis. Even individual clinicians might have their own views about what patients must do before being allowed take-home doses.

States strive to get opioid overdose drug to more people

The requirements help keep patients safe, Parrino said: “Methadone is an incredibly successful medication and it’s extremely effective, but it’s deadly if used unwisely.”

Yet for patients, opioid treatment programs’ monopoly on methadone treatment represents a power imbalance that’s not as apparent in other areas of medicine.

Levander recalled one patient who said her treatment program had increased her required clinic visits from once a month to once every two weeks, and she felt like she had no recourse to challenge that decision.

“Patients know if they lose access to their medication, they may not have another methadone program nearby and they could return to use [of illicit drugs],” Levander said. “The opioid treatment programs have all the power and control. There’s not a lot of desire from patients to rock the boat.”

Haney, the California state lawmaker, has introduced a bill that would remove several barriers to methadone access, including allowing physicians outside of opioid treatment clinics to temporarily prescribe take-home doses. The bill passed out of committee late last month with bipartisan support.

Minnesota lawmakers introduced a bill this year, still in committee, that would bring the state’s rules for dispensing take-home doses in line with federal rules. Some states, such as Massachusetts, issued executive orders adopting many of the new federal guidelines. State agencies in places including Minnesota and Colorado have shifted their rules to adopt a more patient-centered approach to addiction medicine.

But other states haven’t yet followed suit.

“It’s so highly variable as far as where states are on this issue,” said Bobby Mukkamala, a physician in Flint, Michigan, who is on the board of trustees at the American Medical Association. “Some states are way ahead at truly looking at substance use disorder as a medical condition, not something to be punished.”

Methadone monopoly

Meanwhile, a bipartisan bill in Congress could further deregulate the opioid treatment industry and open methadone treatment nationally to physicians outside of clinics. U.S. Sen. Edward Markey, a Democrat from Massachusetts, and U.S. Sen. Rand Paul, a Republican from Kentucky, have introduced legislation that would allow physicians trained in addiction treatment to prescribe methadone outside of a clinic.

It’s a move supported by several national organizations, including the American Medical Association.

“If it’s the restriction that’s stopping patients with these issues from seeing a physician to help, then we need to remove it,” said Mukkamala.

Long Stigmatized, Methadone Clinics Multiply in Some States

But the opioid treatment program industry is pushing back. Parrino noted that many opioid use disorder patients have other associated conditions, from HIV to emotional trauma, that require the kind of comprehensive and regimented treatment available from a certified clinic.

Earlier this year, Markey suggested opioid treatment clinics have more financially driven motivations for their opposition to expanding methadone to non-clinic settings.

“Ultimately, tethering methadone exclusively to opioid treatment programs is less about access, or health and safety, but about control, and for many investors in those programs, it is about profit,” he said in a February statement about the new rules.

Nearly two-thirds of opioid treatment programs are operated by for-profit companies. At least 562 of those are financed by private equity firms, according to a STAT News analysis. Private equity’s involvement in health care has been the subject of an avalanche of scrutiny from lawmakers, advocates and researchers in recent years.

A growing body of research supports methadone’s deregulation. A 2022 survey of opioid treatment patients in a Midwest community found more than half reported travel and work conflicts kept them from treatment. Last year, researchers found that flexible methadone take-home policies were associated with fewer overdose deaths among Black and Hispanic men. Another recent study found that take-home flexibility of methadone did not lead to more methadone-involved deaths.

Haney, the California lawmaker, thinks moving methadone beyond clinic walls would benefit not just people with opioid use disorder, but also their surrounding communities, such as the Tenderloin.

“These outdated policies come from a fear of these patients and a fear of this medication that’s misguided,” he said. “It’s fueling the crisis that we are now facing.”

This story is republished from Stateline, a sister publication of the Kentucky Lantern and part of the States Newsroom network.

Naloxone (Narcan) nasal spray can reverse the effects of opioid overdoses. (Photo by Drew Angerer/Getty Images)

Boone County is set to hire three new workers aimed at addressing the multifaceted challenges posed by the opioid crisis.

On Tuesday, the Boone County Fiscal Court approved a resolution allowing the use of opioid abatement funds to hire up to three police navigators/social workers — a newly created position.

“This is one of the greatest uses of the dollars, overall I would say,” Boone County Judge/Executive Gary Moore said. “The program has tremendous potential in many ways.”

The money comes from a $26 billion settlement between multiple states and some of the United States’ largest pharmaceutical corporations, specifically, drug distributors — McKesson Corp., AmeriSourceBergen and Cardinal Health — and manufacturer Johnson & Johnson. Kentucky received $478 million from the settlement; half of the money was distributed to the state, while the other half went to local government.

Boone County is set to receive an estimated $4.6 million distributed in yearly allotments until 2038, according to a database published by the Kentucky Association of Counties.

To decide how to use the funds, Boone County Administrator Matthew Webster said that throughout 2022 and 2023, county staff consulted with community stakeholders impacted by the opioid epidemic, such as the sheriff’s department, drug court, and the cities of Florence, Walton and Union, among others.

Ultimately, the county created a new position under the sheriff’s department. Laura Pleiman, thedirector of Community Services and Programs for the fiscal court, worked with the sheriff’s department and other community agencies to craft a job description, protocols and plans for the new police navigator/social worker position. The position will be housed under the sheriff’s department.

Webster said the position would provide, “relief to frontline deputies while addressing non-law enforcement issues that currently require the time and attention of sworn officers with a particular emphasis on opioid use and its tangential impacts.”

Moore explained that the workers are there “when law enforcement has stabilized a situation,” but there still needs to be someone present to engage with family members or other present individuals.

The county plans to wait to hire the three staffers; instead, it will hire two in the coming months to adequately develop the program. The position would pay around $78,000 annually, Webster said.

Other police departments in Northern Kentucky already have similar staff positions. Pleiman said the county worked closely with the Alexandria Police Department social workers to develop the position.

“I would say probably that Northern Kentucky is leading the way a lot in this area,” Pleiman said.

This story is republished from LINK nky.

Sen. Max Wise (LRC Public Information)

Four years after leading the effort to cut corporate middlemen out of the prescription drug business for Kentucky’s Medicaid program, Sen. Max Wise now is taking aim at those same companies’ role in private health insurance.

Noting his Senate Bill 50, enacted in 2020, resulted in millions of dollars in savings to Kentucky Medicaid, Wise, R-Campbellsville, has filed a measure meant to restrict the role of companies known as pharmacy benefit managers, or PBMs, in commercial health insurance.

Reprieve for Kentucky’s independent pharmacies is saving Medicaid millions

The Kentucky Lantern last year reported state officials estimated Wise’s bill eliminating outside PBMs from state Medicaid resulted in about $283 million in savings between 2021 and 2022—savings plowed into expanded Medicaid dental benefits for adults.

Wise, in a news release, said he believes Senate Bill 188, filed Feb. 8, will aid many more Kentuckians’ access to prescription medication and help struggling local pharmacies.

“I’m optimistic this measure will yield similar savings by applying the same standards to the commercial market, effectively cutting costs for Kentuckians with private health insurance plans,” Wise said.

The news release said it would also help the state’s around 500 independently owned drugstores, with at least 64 having closed in the past two years.

Pharmacists throughout Kentucky have complained that PBM’s extreme cost-cutting measures have reduced their revenue and left them struggling to survive, as PBMs kept a share of proceeds for themselves.

PBMs, many owned by large pharmacy chains, have argued they save money by processing prescription drug claims more efficiently and at better prices.

CVS Health says on its website that its PBM business, CVS Caremark, helps “increase access to care, deliver better health outcomes and help lower overall health care costs” for consumers.

CVS and other national PBMs unsuccessfully fought Wise’s 2020 bill which eliminated their role in Kentucky’s $15 billion a year Medicaid program and instead directed the state to hire a single, independent PBM to oversee Medicaid’s about $1.2 billion a year prescription drug business.

They likely will oppose Wise’s bill but lawmakers in recent years have expressed increased skepticism about the role of PBMs in Kentucky and other states including Ohio and West Virginia.

Monday’s news release said SB 188 “builds on the success” of Wise’s legislation affecting Medicaid prescription drugs.

Among the drugs Kentucky children are ingesting: opiods, fentanyl, drugs used to treat opioid use disorder, and increasingly, cannabis or products containing THC, the main chemical in marijuana.(Getty Images)

Kentucky’s youngest children continue to be at risk of drug overdoses from accidental ingestion — with the number of fatalities and the strength of the drug, or combination of drugs, increasing.

Eight children died from ingesting drugs and another 47 suffered an overdose in fiscal year 2022 among cases reviewed by the Child Fatality and Near Fatality External Review Panel, which released its annual report Thursday.?

The majority of overdose victims in the report were age 4 or younger.

Five years ago, by contrast, one child died among the 32 overdose cases it reviewed, the panel reported.

And just a fraction of child overdoses in Kentucky are identified in the report since the panel reviews only cases where abuse or neglect is suspected in the death or near-death of a child.

In 2022, 721 children were treated in Kentucky hospital emergency rooms for drug ingestion, with 72 requiring hospitalization, according to emergency department data, the report said.

Dr. Melissa Currie, a forensic pediatrician and founding member of the panel, said such cases are among her greatest concerns.

“I do believe ingestions are a major problem and it’s getting worse rapidly,” said Currie, a professor of medicine with Norton Children’s Hospital and the University of Louisville medical school. “We need to do a better job of educating parents about how dangerous that is.”

Drug use in the home presents the greatest risk, the report said.

“Children living in a home with a caregiver using illicit or other dangerous substances are at a higher risk of accidental ingestion,” the report said. It said children also are at risk of ingesting drugs used to treat opioid use disorder, such as buprenorphine.

Among the drugs children are ingesting: opiods, fentanyl, drugs used to treat opioid use disorder, and increasingly, cannabis or products containing THC, the main chemical in marijuana.

Often such cases involve a combination of drugs.

One example it cited: A 19-month-old who died tested positive for fentanyl and morphine in a home where an adult overdose death had occurred just two months before and where both parents reported using heroin. Two other children in the home tested positive for fentanyl, a powerful, synthetic opioid.

Cannabis products were linked to the deaths of two children who ingested them, the report said.

Currie said the public doesn’t realize the risks even of legal products derived from hemp, such as gummies.

“It can still put kids in the ICU,” she said.

Most deaths or injuries preventable

Created in 2012 to conduct comprehensive reviews of child deaths and serious injuries from abuse or neglect, the independent panel of physicians, judges, lawyers, police, legislators and social service and health professionals meets regularly throughout the year to analyze such cases.

It is charged with producing an annual report to detail its findings to the governor, lawmakers and other officials along with recommendations for improving conditions for children in a state that has long ranked high for its rate of child abuse and neglect.

State Sen. Danny Carroll, R-Paducah, and a member of the panel, said he has not had an opportunity to review the final report but a spokesman said Carroll and the General Assembly generally consider its findings in crafting public policy.

The 2024 report includes cases from July 1, 2021 to June 30, 2022, and examines 202 cases in which 68 children died and 134 suffered life-threatening injuries.

Of the deaths, the majority were from neglect and 10 from physical abuse.

It found that nearly all — 90% — of the deaths and injuries could have been prevented with appropriate precautions, such as safely storing medications or securing firearms.

Areas the panel examined this year included drug overdoses, physical abuse, neglect, firearm deaths including suicide and the role of the Cabinet for Health and Family Services in responding to reports of child abuse and neglect.

Common factors in child deaths and injuries included household financial stress, mental illness, family violence and addiction.

Here are some of the key findings and recommendations:

Overdose and ingestion cases

In light of a rise in such cases over the past five years, the panel recommends better education for all professionals involved in medication assisted treatment for adults with addiction.?

Among child ingestion cases the panel studied, 37% of their caregivers were receiving such treatment including medication for opioid misuse.

That training should stress reminding patients to safely store medication and for health professionals to report when a parent relapses.

It also recommends the Kentucky Board of Medical Licensure provide more continuing education to doctors on opioid ingestion in children.

The report also recommends training for medical marijuana providers. The Kentucky General Assembly in 2023 approved the use of medical marijuana for certain serious conditions though the law does not take effect until 2025.

It also urges more public education on safe-sleep practices and the dangers of a child sleeping with an adult, especially one who is impaired.

“Drinking and drug use (even prescribed) impair our ability to care for a child, making bed-sharing and other unsafe sleep practices even more dangerous,” the report said.

The panel, for the seventh year in a row, asked lawmakers to fund family recovery courts statewide, now offered only in Jefferson and Clay counties.

And it urges a statewide system to create a “Plan of Safe Care,” a federally required system to track and assist families with children at risk, particularly infants born exposed to drugs.

Despite the federal requirement,? Kentucky — and most states — have not fully implemented such a system with responsibility not clearly defined.

“We need to put this on everyone’s radar,” Currie said. “Somebody needs to step in and take responsibility or the legislature needs to assign responsibility.”

Firearms a ‘deadly means’

The report notes access to firearms continues to put children at risk.

In one case, a 4-year-old playing with a loaded handgun he found in the glove compartment of a car fatally shot himself. In another, a 14-year-old was fatally shot in the head by a friend while handling a loaded firearm in the parents’ bedroom.

It also factors in child suicides, the report citing the death by suicide of a 14-year-old boy who had access to unsecured firearms in the home.

The panel reviewed seven suicide cases from 2022, five fatal — four involving a firearm — and two attempts resulting in serious injury. The average age of the child was 13.

Sadly, the panel reports, the cases? it reviewed were just a portion of all suicide deaths of youths in Kentucky for 2022, when a total of 29 children under 18 died by suicide..

The report cited “a significant increase” in firearm injuries in cases it reviewed for the past five years involving 48 deaths and 24 near fatalities.

The panel classified such cases as “access to deadly means” that were largely preventable. In many cases, parents had told children not to handle firearms or thought they had hidden the weapon, the report said.

“Contrary to the beliefs of many parents, research demonstrates most children know where guns are stored and will touch a firearm if provided the opportunity despite education not to touch the firearm,” it said.

The panel recommends the legislature research national models and develop legislation to promote safe storage of firearms.

Currie said she understands firearms legislation is controversial but said it shouldn’t be when it comes to child safety.

“It should be a non-issue,” she said. “That should be something we can all agree on.”

Rep. Deanna Frazier Gordon, R-Richmond, the primary sponsor of House Bill 31, smiles as a motion is made to approve her bill during the House Health Services Committee meeting, Jan. 25. (LRC Public Information)

FRANKORT — A bill that would require Kentucky Medicaid to cover at-home blood test kits passed the House 93-0 Monday.

House Bill 31 can now advance to the Senate.

HB31 would make life easier for Medicaid patients who take blood thinners for their mechanical heart valves. Some patients need the blood thinners after drug use with an infected needle caused fungal growth on their heart valves.

Medicaid would cover at-home INR tests under proposed law

Getting a mechanical valve replacement means a person must be on blood thinners like coumadin for the rest of their life, meaning they also must get their blood tested on a weekly basis.

This bill would make sure Medicaid patients could get International Normalized Ratio (INR) kits for at-home finger prick testing rather than needing to travel to a medical facility for the blood draw.

Sponsor Rep. Deanna Frazier Gordon, R-Richmond, said on the House floor Monday that this at-home testing “is the preferred method of testing by doctors and surgeons.”

“Dosage adjustments can be made quickly by the health care provider,” she added. “It decreases risk of stroke or bleeding events and it allows the patient to see the results immediately.”

Approximately 3,000 Kentuckians would benefit if the bill becomes law, the Lantern previously reported.

Naloxone (Narcan) nasal spray can reverse the effects of opioid overdoses. (Photo by Drew Angerer/Getty Images)

The Lexington-Fayette County Health Department announced it is seeing “an unusually high number of suspected nonfatal drug overdoses” a week into 2024.?

There were 29 such overdoses Jan. 4-7, the health department reported, compared with 17 the previous week.

“This is an important time to carry naloxone, used to reverse opioid overdoses, especially if you or someone you know has substance use disorder,” the health department said in a statement. “Fentanyl has been found in all types of regulated drugs, so naloxone may help regardless of the drug taken.”?

Signs of an overdose include labored breathing, unresponsiveness, choking and more.?

If you think someone is overdosing, here’s what experts say to do:?

• First, call 911 so help is on the way.
• Try speaking to the person. For example, say: “I believe you might be overdosing, and I am going to administer Narcan.”?
• Rake your knuckles over the person’s chest. This may also elicit a response.?
• If the person isn’t responsive, administer Narcan.?

A box of Narcan comes with user instructions, which include these rescue steps:

• Put the person on their back.?
• Tilt the person’s head back.?
• Insert the Narcan nozzle into one of the person’s nostrils.?
• Press the plunger and then remove the nozzle from the nose.?
• If the person doesn’t respond, in two minutes, repeat the process.?
• Stay with the person until emergency medical staff arrive.?

D. Christopher Evans leads the Kentucky Opioid Abatement Advisory Commission.

A veteran of the U.S. Drug Enforcement Administration will lead the Kentucky commission that is overseeing distribution of millions of dollars from opioid settlements, Attorney General-elect Russell Coleman announced Tuesday.

Christopher Evans, who started as a street agent and served as the DEA’s acting administrator in 2021, will become the new executive director of the Kentucky Opioid Abatement Advisory Commission, Coleman said.

According to a news release, Evans served in various DEA leadership roles, including as the first special agent in charge of the newly-created Louisville Field Division in which he partnered with then-U.S. Attorney Coleman to open a DEA Office in Paducah. ?Evans now ?serves on the board of directors of the Christopher 2X Game Changers organization in Louisville and the Kentucky State Police Foundation.

Evans will succeed Bryan Hubbard, outgoing Attorney General Daniel Cameron’s choice to lead the opioid commission. Hubbard championed putting $42 million in settlement funds into researching ibogaine, a psychedelic drug now illegal in the U.S., as a method for easing withdrawal from opioids.

Other appointments announced by Coleman on Tuesday:

• Rewa Zakharia will serve as Coleman’s criminal chief. She now serves director of special prosecutions in the AG’s office. Zakharia previously served as an assistant commonwealth’s attorney in Fayette County in the special victims unit where she tried the first labor trafficking case in Kentucky.
• Richard Ferretti, commissioner of the Department of Criminal Investigations (DCI), is a former Army officer and tank commander who brings 30-plus years of career law enforcement experience, including in the U.S. ?Secret Service and the Kentucky AG’s office.
• Solicitor General Matt Kuhn will continue to oversee the civil and criminal appeals.
• Justin Clark will return to the attorney general’s office as the civil chief. ?Clark is currently the chief legal officer for a Louisville-based technology company. He was previously a litigator in the AG’s office. He’s also served as general counsel of the Kentucky Cabinet for Health and Family Services and as commissioner of the Kentucky Boxing & Wrestling Commission.
• Christopher Thacker will continue to serve in the AG’s office, becoming the new general counsel. Thacker currently is the head of the civil division, where he successfully argued to block President Joe Biden’s vaccine mandate for federal contractors. Thacker previously served as chairman of the Kentucky Executive Branch Ethics Commission and was appointed to serve as a special justice on the Kentucky Supreme Court.
• Vic Maddox, who currently is deputy attorney general, will continue to serve in the office as counsel to the attorney general for special litigation.
• Amy Burke will take on a new role as the interim chief of child support enforcement. Burke is currently the AG’s criminal chief and was previously the chief prosecutor for the Kenton County Attorney’s Office.
• Jeremy Murrell will be promoted to become the first deputy commissioner for counter exploitation with a mandate from Coleman to “target harden” Kentucky from those preying on our children.
• Tramont Banks will also be promoted deputy commissioner for operations. Banks is currently the director of Department of Criminal Investigation’s Protection Intelligence Division following 20 years with the Louisville Metro Police Department.
• Jessie Halladay will be deputy director of the Kentucky Opioid Abatement Advisory Commission. Halladay, currently a senior policy specialist with the Criminal Justice Institute, has been special advisor to the Louisville Metro Police Department, senior policy advisor to the Kentucky Justice and Public Safety Cabinet and communications director for Jefferson County Attorney Mike O’Connell. Before her government service, Halladay was a public safety and social services reporter for the Louisville Courier-Journal.

“Today, I’m proud to announce a team of powerhouse attorneys and law enforcement professionals who will bring talent and experience to protecting Kentucky families,” said ?Coleman. “Their qualifications represent the very best in their field, not only in Kentucky but also across the country. Every Kentuckian should feel optimistic that we have such incredible public servants who are dedicated to protecting their families from violent criminals, drug traffickers and those who would do us harm. I’m grateful to each of these outstanding individuals who answered the call to serve.”

On Friday, Coleman received a final briefing from his transition team, who have spent weeks reviewing the attorney general’s office and interviewing candidates, according to the news release.

Narcan is an opioid reversal treatment. (Kentucky Lantern photo by Sarah Ladd).

The Pike County School District in Eastern Kentucky will distribute 200 extra boxes of naloxone, commonly called Narcan,?to its campuses and families, thanks to a donation from the national nonprofit HarborPath.

The school district already made the overdose reversal drug available to schools, it said Wednesday, but now has the capacity to provide more doses as well as educational resources to youth and their families in the area.?

As part of the new program, approved unanimously in November by the school board, the district will give out the 200 “rescue kits” to both schools and homes. Each kit includes two doses of narcan plus instructions and recovery education resources.?

Data compiled by The Washington Post shows Pike County among the hardest-hit by the opioid epidemic, which in 2022 killed 2,135 Kentuckians.?

The program is timely. Dr. Susan Bissett, the president of the Drug Intervention Institute, a non-profit based in Charleston, West Virginia, said that “School-aged children are particularly at risk of overdose.”?

“Our institute mission is to reduce overdose deaths in Appalachia and across the nation by proliferating the country with naloxone in the same way fentanyl has proliferated our nation’s drug supply,” Bisset said. “We’ve seen an increase in fentanyl exposure to younger persons throughout the United States. Harbor Path is making strides to protect the children and communities in Pike County Kentucky, and we are proud to partner with them on these efforts.”

Narcan blocks opioid’s effects, according to the Centers for Disease Control and Prevention. It “can restore normal breathing within 2 to 3 minutes in a person whose breath has slowed, or even stopped, as a result of opioid overdose.”?

“We understand students sometimes have difficult situations at home and our goal has always been to support them in every way possible,” Pike County School District Superintendent Reed Adkins said. “Fentanyl is a growing problem and overdoses are occurring across the county at an alarming rate. We hope our students, or their families never need Narcan, but want to have it available if it is needed.”

Narcan blocks opioid’s effects, according to the Centers for Disease Control and Prevention. It “can restore normal breathing within 2 to 3 minutes in a person whose breath has slowed, or even stopped, as a result of opioid overdose.” More than one dose may be necessary.?

“We applaud the Pike Country School District for its efforts to save lives in a region that has been so deeply impacted by the opioid and overdose epidemic,” said HarborPath president Ken Trogdon. “We’re proud to establish this program to supply schools and families with free and accessible Naloxone. It is our mission to ensure overdose rescue supplies are on hand and available in a life-or-death situation.”

A nonprofit worker prepares items for the first Appalachian Save a Life Day naloxone distribution event in September at the Unitarian Universalist Congregation of Charleston in Charleston, West Virginia. Leah Willingham/The Associated Press

Posing as shoppers, a team of researchers from the University of Mississippi called nearly 600 pharmacies across the state and asked a simple, yes-or-no question: “Do you have naloxone that I can pick up today?”

Mississippi enacted a law authorizing pharmacists to sell the opioid overdose reversal drug naloxone — often sold under the brand name Narcan — in 2017. The drug, which can be administered via nasal spray or injection, can prevent death from overdose by blocking the effect of opioids in the body.

The results of the survey, conducted last year, were disheartening: Despite the Mississippi law, 41% of the pharmacies the researchers called refused to dispense naloxone. Only 37% had naloxone available for same-day pickup. Most of the pharmacies saying they could not immediately provide naloxone said it required a prescription, which was false.

“It seems like that refusal might have been driven by a lack of education about the state’s naloxone policy,” said Emily Gravlee, a pharmacist and a doctoral candidate at the University of Mississippi who conceived of and directed the secret-shopper study.

Earlier this year, the U.S. Food and Drug Administration approved Narcan to be sold over the counter. That means that residents in every state can buy it at their local pharmacy without a prescription — at least in theory.

In reality, access remains patchy.

As the Mississippi researchers and other studies have found, pharmacies don’t always keep the drug in stock. And naloxone spray can be pricey for people paying out of pocket; a two-dose pack of Narcan typically retails for about $45-$50. As an over-the-counter medicine, it may not be covered by insurance.

In the past year, more states and municipalities have launched programs to distribute hundreds of thousands of doses of naloxone for free in a myriad of ways: by mail, vending machines, community groups, telehealth, first responders and more.

“We need to normalize that it is not only the humane thing but the appropriate thing to treat people with substance use disorders just like we do people with other diseases,” said Dr. Steven Stack, Kentucky’s commissioner for public health and president of the Association of State and Territorial Health Officials.

“We don’t tell diabetics, ‘I can’t believe you need to have insulin every day,’” Stack said. “We need to recognize people [with substance use issues] as someone with a medical problem. And there are resources available.”

A changing adversary

Drug overdose deaths in the United States have risen fivefold over the past two decades, claiming?nearly 107,000 lives from last June to this June, according to?the most recent?estimates from the federal Centers for Disease Control and Prevention.

Twenty years ago, overdose deaths involving opioids mostly were from prescription drugs such as oxycodone and hydrocodone. In 2010, a new version of the prescription painkiller OxyContin was introduced that was harder to misuse, leading to a rise in the use of illicit opioids such as heroin.

The opioid epidemic continues to mutate. Today, overdose deaths are overwhelmingly caused by fentanyl and other synthetic opioids. They accounted for?nearly 88% of opioid overdose deaths?in 2021, the latest year for which final CDC?data is available.

“In years past, many people who were chronic users of things like heroin or morphine or hydrocodone were experienced and knew their limits, so they didn’t overdose as often,” Stack said. But over the past decade, illicit drugs have increasingly been mixed with fentanyl to make them cheaper and 50-100 times more potent.

“When you get a drug on the street that’s laced with fentanyl, for most people it doesn’t matter what their tolerance already is,” he said. “One experimentation could be deadly, because fentanyl is that powerful.”

Enlisting bystanders

Naloxone is highly effective at reversing overdoses. It typically restores breathing within two to three minutes, and it’s safe even if given to someone without opioids in their system. It’s also non-addictive and doesn’t create a high.

Experts now say it’s vital for family members, coaches, business owners and community members to have naloxone on hand so they can administer it quickly if they encounter someone experiencing overdose, which can cause difficulty breathing and a loss of consciousness. Studies have shown bystanders are present in about one-third of all overdoses, Stack said.

“If you are in the midst of an overdose, you don’t have the capacity to treat yourself,” said Stack. “That’s why we have to make sure it’s in the hands of bystanders or witnesses.”

Last year, the Biden administration directed $1.5 billion to states to help them address the opioid and overdose epidemic, including funding for health departments to buy and distribute naloxone. Through State Opioid Response grants, 6.6 million naloxone kits were distributed and nearly 400,000 overdose reversals reported, according to the National Association of State Alcohol and Drug Abuse Directors.

Most states direct federal and state funding to community groups, local health departments, first responders, needle exchanges and other organizations to help them offer free or low-cost naloxone.

Increasingly, states also?are trying to get the overdose reversal drug to individuals. Last December, the Mississippi State Department of Health launched a service that mails free naloxone kits to residents who request them. The naloxone mailing program is part of a larger statewide?substance use program initiated a few years ago to tackle Mississippi’s overdose crisis. And the state’s overdose rates have shown improvement: Mississippi’s total number of suspected drug overdose deaths?decreased by more than 35% from 2021 to 2022, and the number of opioid-related deaths decreased by more than 25%, according to the most recent data from the Mississippi Opioid and Heroin Data Collaborative.

Other states, including Delaware and Kentucky, also have embraced mail-based delivery programs, offering residents free naloxone through the mail. The nonprofit Harm Reduction Ohio, which mails free naloxone to Ohioans on request, reports having distributed 42,000 naloxone kits last year. Iowa’s Naloxone Iowa initiative offers free naloxone from a pharmacy or by mail for individuals who set up a telehealth appointment with a pharmacist through the University of Iowa’s Tele-Naloxone program.

In Kentucky, Stack’s department is placing boxes filled with free naloxone near high-traffic areas such as shopping centers, sporting events and common areas on college campuses.

States, cities and districts including?Kansas,?Las Vegas,?Michigan, New York City,?Northern Idaho, Philadelphia and?San Diego County also have launched vending machine programs in the past year that offer free naloxone kits.

Dr. Karen Scott, president of the Foundation for Opioid Response Efforts and a physician in preventive medicine, said the recent spike in youth overdose death rates means more middle and high schools should look at making naloxone easily available.

Experts have attributed the increase in the adolescent overdose death rate almost entirely to fentanyl, which is increasingly found in counterfeit pills.

“I appreciate that some school districts will be very hesitant and say, ‘This doesn’t happen here,’” Scott said, “but the data is telling us that we need to be paying more attention to this population and their risk of unintentional overdose.”

Most teens don’t have an opioid use disorder or a long history of drug use, she said. But that doesn’t mean they have no need for naloxone.

“Given the prevalence of [counterfeit] pills in schools, a kid might think they’re getting a valium off their friends or an attention-deficit medication and it’s really fentanyl,” she said. “You don’t have to have a long history of using opioids to be at risk of having an overdose.”

Stateline like Kentucky Lantern is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and Twitter.

Among the drugs Kentucky children are ingesting: opiods, fentanyl, drugs used to treat opioid use disorder, and increasingly, cannabis or products containing THC, the main chemical in marijuana.(Getty Images)

BURLINGTON, Vt. — “You can’t inject a horse tranquilizer and think nothing bad is going to happen” to you, said Ty Sears, 33, a longtime drug user now in recovery.

Sears was referring to xylazine, a sedative used for animal surgeries that has infiltrated the illicit drug supply across the country, contributing to a steady climb in overdose deaths.

Sears divides his time between Burlington and Morrisville, a village an hour to the east. In Burlington, he visits clusters of drug users, offering water, food, and encouragement.

He has been there, been down, done time, struggled to adhere to treatment regimens. But this, he said, is different: first, fentanyl — estimated to be 50 to 100 times as potent as morphine — and now xylazine, and the life-threatening wounds and sores it can cause.

Sears implores those he encounters who suffer the effects of these drugs to look at what they’re doing to themselves. But to little avail.

“They say they’re unable to get out of it — that they don’t have a plan to get out of it.”

Worse, those who seek help breaking their addictions face treatment options rendered less effective by the prevalence of fentanyl, xylazine, and other synthetic drugs. Vermont’s pioneering efforts in establishing a statewide program for medication for opioid use disorder, known as Hub and Spoke, now face significant new challenges.?

Launched in 2012, Hub and Spoke put prescription medicines at the center of the treatment strategy, which many addiction specialists say is the most effective approach. Vermont offers methadone treatment at regional hub sites for those with the most intense needs, while smaller community clinics and doctors’ offices — the “spokes” — provide care such as dispensing the opioid withdrawal drug buprenorphine.?

Advocates and experts in Vermont honed the model, and today hub-and-spoke systems or variations are in place nationwide, including in California, Colorado, Maine, New Hampshire, and South Carolina.

But the rise of fentanyl, xylazine, and stimulants is undercutting the effectiveness of addiction medications.

Commonly administered doses of buprenorphine, better known as Suboxone — the brand name for a combination of buprenorphine and naloxone — have proved less effective against fentanyl, and commonly used doses can trigger violent, immediate withdrawal. Neither Suboxone nor methadone is designed to treat addiction to xylazine or stimulants.?

The Centers for Disease Control and Prevention estimates that of the more than 111,000 drug-overdose deaths in the U.S. in the 12-month period ending in April, more than 77,000 involved fentanyl and other synthetic opioids. The nation has also seen a significant increase in overdose deaths from co-use of stimulants and opioids. Vermont has experienced a spike in the use of cocaine and, more recently, methamphetamine.

“There was a time when we couldn’t have pictured things being worse than heroin,” said Jess Kirby, director of client services for Vermonters for Criminal Justice Reform, which offers services to counter substance use disorder. “Then we couldn’t picture things being worse than fentanyl. Now we can’t picture things being worse than xylazine. It keeps escalating.”

In Vermont, the Hub and Spoke program is part of the statewide Blueprint for Health, with hubs in relatively populous areas of this largely rural state.

A patient enters the system for assessment and initial induction at one of nine hubs, and then, once stable, is transferred to a spoke. If that patient relapses or needs more intensive care, they can be transferred back to the hub. The spokes typically offer Suboxone — most effective for those with mild to moderate opioid dependence — but not methadone, which is more regulated.

Kirby — who began using opioids in her early teens, has been in recovery for about 15 years, and is Ty Sears’ longtime case manager — said a benefit of the hub-and-spoke model is that it offers support to primary care doctors and other practitioners who might otherwise be hesitant to prescribe medications to treat addiction. (Federal officials recently relaxed rules governing which doctors can prescribe buprenorphine.)

Erin O’Keefe, who runs the Burlington-based Howard Center Safe Recovery program, said the model’s flexibility has been key: from being fully integrated into primary care, whereby addiction is treated like any other chronic disease, to the other end of the spectrum, “making sure that people who are still in chaotic-use cycles receive harm reduction approaches” to keep them alive another day.

Vermont had the 10th-largest increase in fentanyl deaths for the 12-month period ending in April. Tony Folland, clinical services manager with the Vermont Department of Health’s Division of Substance Use Programs, said fentanyl is now implicated in about 96% of overdose deaths.

Meanwhile, xylazine, commonly called “tranq,” is causing extreme concern. State Department of Health records indicate that almost 1 in 3 opioid overdose deaths so far this year involved xylazine. And those working on the front lines report seeing a marked increase in the extreme wounds it often causes.

The challenges providers now face underscore the need to be prepared to respond in the moment. It’s essential, O’Keefe said, to capitalize on someone’s motivation for change, “and that motivation can be so fleeting — like, ‘I have enough in the tank to make one phone call, and if that phone call doesn’t go well, I’m back in the game.’”

Folland said Vermont now prescribes more medication for opioid use disorder per capita than any other state. He estimates between 45% and 65% of people with opioid use disorder receive medication.

But these challenges are unprecedented. “We have a drug supply that’s contaminated with xylazine, with fentanyl, and we know that people are struggling a lot more and are at a lot higher risk,” Kirby said. “It’s not just overdose to be concerned about anymore. It’s life-threatening wounds and infections.”

In response, advocates have asked state officials to fund more contingency management, a treatment approach that provides rewards to patients who refrain from illicit drug use. They also strongly encourage more widespread access to methadone as an alternative to buprenorphine, which is often proving less effective in countering the potency of fentanyl.

According to Folland, eight opioid treatment programs in communities throughout the state offer methadone, with one more soon to come. The goal, he said, is to prevent anyone from having to travel farther than a half-hour or so to access it.

Easier access to methadone would also require loosening federal restrictions.

“Methadone is probably the most regulated medication in the United States. We’ve got to figure out a way to make it more accessible,” said Kelly Peck, director of clinical operations for the University of Vermont Center on Rural Addiction. “We’ve got decades worth of data at this point, showing that methadone is safe and efficacious.”?

For Kirby, O’Keefe, and their colleagues, more resources can’t come quickly enough.?

“People dying — that’s what I’m seeing, every day,” Sears said.

Sears has been fortunate. What has served him in his recovery is the tolerance of those who’ve helped him along the way, and flexibility. There have been times when he was allowed to remain on Suboxone while still using stimulants. He is a recent graduate of a contingency management program administered by Vermonters for Criminal Justice Reform, the organization for which Kirby works.

“She counsels me,” Sears said. “She hears me out.”

Glimpsing a flicker at the end of the tunnel, advocates acknowledge, will require availing an arsenal of options to counter a shifting, and lethal, crisis.

“It’s almost like our understanding is changing from really seeing this, on a social level, as episodic to seeing it as chronic,” O’Keefe said, emphasizing that as the drug-supply landscape shifts, approaches to countering it must evolve as well.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

Opioid settlement cash is not inherently political. It’s not the result of a law passed by Congress nor an edit to the state budget. It’s not taxpayer money. Rather, it’s coming from health care companies that were sued for fueling the opioid crisis with prescription painkillers.

But like most dollars meant to address public health crises, settlement cash has nonetheless turned into a political issue.

Gubernatorial candidates in several states are clashing over who gets bragging rights for the funds — which total more than $50 billion and are being distributed to state and local governments over nearly two decades. Among the candidates are attorneys general who pursued the lawsuits that produced the payouts. And they’re eager to remind the public who brought home the bacon.

“Scoring money for your constituency almost always plays well,” said Stephen Voss, an associate professor of political science at the University of Kentucky. It “is a lot more compelling and unifying a political argument than taking a position on something like abortion,” for which you risk alienating someone no matter what you say.

In Kentucky, Attorney General Daniel Cameron, the Republican candidate for governor, wants sole credit for the hundreds of millions of dollars his state is receiving to fight the opioid epidemic. In a post on X, formerly known as Twitter, he wrote that his opponent, former attorney general and current Democratic Gov. Andy Beshear, “filed a lot of lawsuits during his time [in] office, but in this race, there is only one person who has actually delivered dollars to fight the opioid epidemic, and it’s not him.”

However, Beshear filed nine opioid lawsuits during his tenure as attorney general, several of which led to the current payouts. At a January news conference, Beshear defended his role: “That’s where these dollars are coming from — cases that I filed, and I personally argued many of them in court.”

Polls indicate that Beshear leads Cameron ahead of the Nov. 7 election.

Christine Minhee, founder of OpioidSettlementTracker.com, who is closely following how attorneys general handle the money nationwide, said voters likely don’t know that the opioid settlements are national deals crafted by a coalition of attorneys general and private lawyers. So when one candidate claims credit for the money, his constituents may believe “he’s the sole hero in all of this.”

Candidates in other states are touting their settlement credentials, too. North Carolina Attorney General Josh Stein, a Democrat, lists securing opioid settlement funds at the top of the “accomplishments” section of his 2024 gubernatorial campaign website. West Virginia Attorney General Patrick Morrisey, a Republican gubernatorial candidate for 2024, has repeatedly boasted of securing the “highest per capita settlements in the nation” in news conferences and on social media and his campaign website.

In Louisiana, Attorney General Jeff Landry, a Republican who was recently elected governor, ran on a tough-on-crime platform, with endorsements from sheriffs and prosecutors. As attorney general, he led negotiations on dividing opioid settlement funds within the state, resulting in an agreement to send 80% to parish governments and 20% to sheriffs’ departments — the largest direct allocation to law enforcement in the nation.

It’s a common joke that AG stands for “aspiring governor,” and officials in that role often use big legal cases to advance their political careers. Research shows that attorneys general who participate in multistate litigation — like that which led to the opioid settlements and the tobacco settlement before it — are more likely to run for governor or senator.

But for some advocates and people personally affected by the opioid epidemic, this injection of politics raises concerns about how settlement dollars are being spent, who is making the decisions, and whether the money will truly address the public health crisis. Last year, more than 100,000 Americans died of drug overdoses — 2,135 of them in Kentucky.

Average people “don’t really care about the bragging rights as much as they care about the ability to use that funding to improve and save lives,” said Shameka Parrish-Wright, director of VOCAL-KY, an advocacy group that champions investments in housing and health care.

“What I see in my state is a lot of press conferences and news pieces,” said Parrish-Wright, a Democrat who is active in local politics. “But what plays out doesn’t get to the people” — especially those deeply affected by addiction.

For example, when Beshear celebrated a decrease in the state’s overdose deaths, his announcement overlooked the increasing deaths among Black Kentuckians, Parrish-Wright said. And when Cameron’s appointee to the state’s opioid abatement advisory commission announced that $42 million of settlement funds were being considered to research ibogaine — a psychedelic drug that has shown potential to treat addiction — Parrish-Wright’s first thought was “most poor people can’t afford that.” To obtain it, people often have to travel out of the country.

The ibogaine announcement caused additional controversy. It’s an experimental drug, and, if approved, the $42 million allocation would be the single-largest investment from the commission, which is housed in Cameron’s agency. The Daily Beast reported that a billionaire Republican donor backing Cameron’s gubernatorial campaign stands to reap massive profits from the drug’s development.

Neither Cameron’s office nor his campaign responded to requests for comment.

Beshear’s office declined an interview request but referred KFF Health News to his previous public statements, in which he criticized the potential investment in ibogaine. He has suggested Cameron — whose campaign has emphasized support for police — is not putting his money where his mouth is.

“If you only provide $1 million to law enforcement and 42 to pharma, it doesn’t seem like you’re backing the blue. It seems like you’re backing Big Pharma,” Beshear said at a May news conference.

He also said his two appointees to the commission were caught off guard by the public announcement on ibogaine, despite their role overseeing settlement funds.

Minhee, founder of OpioidSettlementTracker.com, said she’s concerned that mixing politics with settlement funds could result in ineffective investments nationwide.

“If some of this money is going to be politicized to advance careers of attorneys general who support the war on drugs, then that is literally using monies won by death to feed into more death,” she said.

Parrish-Wright, of VOCAL-KY, said she worries that candidates — and some voters — will forget about the significance of the money once ballots are cast.

“We cannot let it fade after the election cycle,” she said.

Her solution depends in part on politics. She’s on the ballot herself Nov. 7, for a seat on Louisville’s Metro Council. If she wins, she said, she intends to keep the settlement in the public conversation.

This story is republished from?KFF Health News?is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at?KFF — the independent source for health policy research, polling, and journalism.

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

In a session focused on challenges of getting the psychedelic drug ibogaine approved by the Food and Drug Administration for treating addiction with help of the state’s opioid settlement funds, a cardiologist said it couldn’t be done in a reasonable time and the drug is unsafe.

“My opinion is that ibogaine is not safe, the efficacy is unproven, it’s unlikely to be approved by the FDA in a reasonable time period, and the cost to Kentucky would be unsupportable,” said Dr. Mark Haigney, a board-certified cardiologist and electrophysiologist, and an attending physician at the Walter Reed National Military Medical Center.

Haigney was invited to a special Kentucky Opioid Abatement Advisory Commission meeting on Oct. 17 by commission member Patricia Freeman, a pharmacy professor at the University of Kentucky. The meeting also saw the head of the commission discuss a “rough” plan for funding ibogaine research.

After two hearings that focused on ibogaine development and personal testimonies favoring the drug, she asked to invite experts in regulatory drug development to testify about the challenges of navigating ibogaine through the FDA process, given its potential for damage to the heart and its current classification as a Schedule I drug with no medical use.

Freeman said she had concerns that people at one hearing thought there would be quick access to ibogaine with the $42 million investment and felt compelled to ensure they understand that this would be a multi-year endeavor with no guarantee of success.

“I felt this was important as it would help make sure that at large, our commission would be as fully informed as possible prior to making a decision on proposed ibogaine funding,” Freeman said.

The proposal comes from Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor. Cameron appointed Hubbard to ?lead the distribution of $842 million in opioid settlements from drug companies. Ibogaine is illegal everywhere but Mexico and New Zealand, but has been anecdotally reported to stop drug-withdrawal symptoms.

Haigney, who described himself as an “expert in drug-induced sudden death and drug-induced loss of consciousness,” said that while he recognized the attractiveness of a single-dose drug like ibogaine to treat opioid-use disorder, such a drug must be “safe in the immediate term, effective in the long term, FDA-approved, and affordable for the huge number of Kentuckians with opioid-use disorder.”

He said ibogaine isn’t safe because it is known to cause cardiac arrhythmias and sudden death. In detail, he explained that this happens because ibogaine causes a “prolonged QT interval,” which is one of the measurements taken by a standard electrocardiogram.

A prolonged QT interval occurs when the heart muscle takes longer to contract and relax than usual, which can affect heart rhythms and lead to sudden cardiac arrest.

Haigney said the FDA requires all drugs to undergo cardiac testing and that “the finding of QT interval prolongation is the most common reason for removal of a drug from further development.”

He added that a prolonged QT interval can happen when a drug blocks the cardiac potassium channels to the heart and that ibogaine is a “potent blocker” of this channel, even with normal therapeutic doses.

“So this means that most if not all subjects would experience some significant degree of blocking the channel,” he said. “And this is a very poor prognostic finding for a drug.”

Haigney pointed to a study of 14 hospitalized patients who received a “relatively low dose” of ibogaine. The average increase in QT interval was 95 milliseconds. He said the FDA’s published guidelines say it is concerned when a drug prolongs the QT interval by 5 milliseconds or more.

“I’ve never seen a drug prolong the QT interval so profoundly,” he said, adding later, “This degree of QT prolongation would be expected, associated with increased risk of fatal events.”

He then asked rhetorically, “Can this drug be given safely?” His answer, “Yes, in the hospital. We do a lot of dangerous things in the hospital with a lot of technology,” adding that this would be “an incredibly resource-demanding” drug to administer.

“The likelihood that this drug with this safety profile will be approved by the FDA in less than 10 years, in my opinion, is remote and the effort will require at least a billion dollars,” Haigney said. “The administration of ibogaine would strain hospital resources at a time when bed shortages are severe. This is a treatment for wealthy individuals who can pay for hospitalization with intensive monitoring,” so it would not help most Kentuckians “who struggle with opioid dependence.”

Dueling experts

Freeman also invited Robert Walsh, recently retired from working in the National Institute on Drug Abuse for 36 years, where he headed NIDA’s Regulatory Affairs Branch.

Walsh spoke to the regulatory challenges of ibogaine development, including cardiac safety, ensuring enough supply of a plant-based drug from another country, creating a plant-based drug with the same dose in each pill, and the challenges of working with a Schedule I drug in laboratories and clinical settings.

Dr. Sidney Peykar, a cardiac electrophysiologist and medical director at the Cardiac Arrhythmia Institute, said the drug could be given safely in a hospital setting and said he has expanded the protocol for how to administer ibogaine safely at the Beyond Ibogaine Treatment Center in Cancun, Mexico.

“Most if not all of these deaths could be mitigated or completely prevented through safety protocols,” he said.

Dr. Javier Muniz, the FDA’s supervisory general-health scientist for controlled-substances initiatives, was asked if FDA would definitely not approve ibogaine. He said that without all of the information in front of him, “I have no idea.”

Asked by Freeman if a 95-millisecond QT prolongation would disqualify ibogaine from being approved, he said it’s important to remember that when the FDA is considering the approval of a drug, the agency looks at a drug holistically and considers both risks and benefits.

Hubbard was asked after the meeting if any speaker had caused him to change his mind about his ibogaine plan. He said, “Dr. Haigney was brought in here to oppose this initiative and he articulated all of the talking points that the opponents of this initiative have already parlayed at public remarks. So there was nothing that was either surprising, nor persuasive about his remarks, and insofar as what he has articulated, are already widely publicly disseminated talking points of opposition.”

He said Haigney was “thoroughly debunked [by] individuals who serve, respectively, on an FDA advisory board for psychopharmacology, as well as the science journal for the FDA’s research arm related to controlled substances.”

What’s next

At the end of the meeting, Hubbard gave the commission a “very rough draft” of a plan with a list of requirements that would have to be met before the commission would commit $42 million to the project. He did not release the plan, but told Kentucky Health News after the meeting that it contains these points:

• “Viable research proposals from qualified research entities” that will match the state’s $42 million
• The state would have ownership of any patentable intellectual property that is generated
• Clinical trials would be held in the West End of Louisville and in Wast Kentucky, “in a way that ensures social, racial, and economic equity of access to the treatment,”
• An approved drug-investigation application from the FDA “with secured clinical-trial sites and a diverse group of qualified clinical-trial participants before the first dollar is ever matched by the commission,”

“This will have to be a viable, go project before any commission resources are put on the table,” Hubbard said,. Nothing like this has ever been done. So all of this is breaking ground.” He cited “the competing interests, the areas of concern, the nature of this money, the necessity of protecting it, the necessity of making sure that the Commonwealth of Kentucky has a leadership position that is protected and recognized, and consideration of risk that we are taking by making this bet.”

When it comes time for the commission to vote, he said, “Theoretically, the vote will be to legally authorize a $42 million match from the commission for our clinical research team that is ready to conduct clinical trials with ibogaine in Kentucky.”

Hubbard said it is imperative that no vote be taken until Dr. Nolan Williams’ peer-reviewed research of veterans who have suffered from traumatic brain injury and received ibogaine is published and they hear from him about his findings. Williams is an associate professor at Stanford University.

At the commission’s first public hearing, Williams said he had let other professionals look at the data from his study and they said “the findings are shocking and that they’ve never seen a drug do this before.”

Before the eight guests spoke, Hubbard took about five minutes to address how he and the commission came to explore ibogaine and its potential therapeutic uses. He said as far back as 2018, he became aware of emerging science on therapeutic psychedelics and an author who at the time wrote about the topic and led him to other sources of information. Her newsletter The Journey is published on Substack. She wrote under the pen name of Julia Blum now uses the name Julia Christina.

Hubbard was responding to an Oct. 9 Daily Beast story, excerpted in Kentucky Health News, which reported that about the time Cameron implicitly endorsed his plan at a public event, a major national political contributor increased its investment in ibogaine research and later gave Cameron’s campaign a political boost. He is running against Democratic Gov. Andy Beshear, who has objected to Hubbard’s ibogaine plan.

Hubbard said, “It’s important to set the record straight in full public view, lest the fictitious narrative of a smoke-and-mirror smear job generated by a third-rate, agenda-driven political tabloid prevail in the public arena against the integrity and sincerity of all who have offered their time, expertise and visceral lived experiences for all the world to see on behalf of all Kentuckians.”

The commission’s next regular business meeting is scheduled for 1 p.m. Nov. 14 at 1024 Capital Center Dr., Suite 200, Frankfort.

Attorney General Russell Coleman proposed a $3.6 million opioid prevention program aimed at youth. (Getty Images)

Kentucky Attorney General Daniel Cameron announced Monday the distribution of $13.9 million in grants to organizations fighting the opioid epidemic through recovery and prevention services in Kentucky.?

Standing in the Capitol Rotunda, Cameron called the opioid crisis the “public safety challenge of our lifetime” that continues to be “unacceptable.”?

“We could have the finest schools, the lowest taxes and the region’s most ambitious economic development plans,” he said. “But none of that matters if drugs continue to take thousands of Kentucky lives and wreak havoc on thousands of Kentucky families each year.”?

The funds were allocated by the 11-member Kentucky Opioid Abatement Advisory Commission, whose job it is to distribute the state’s more than $800 million in opioid settlement funds.?

Although Kentucky saw its first decline in fatal overdoses since 2018 last year, 2,135 Kentuckians died from an overdose in 2022. Most of those deaths were from opioids, especially fentanyl, the Lantern previously reported.?

“The opioid epidemic has plagued our people for far too long,” Cameron said. “This money that the commission has allocated – we’re certainly hopeful that it will start to stem the tide of this epidemic.”??

The recovery and prevention grant recipients and their awards are:?

• Franklin County Women and Family Shelter – $134,750??
• Kentucky River Foothills Development Council – $500,000?
• Recovery Cafe of Lexington – $657,000
• Feed Louisville – $500,000
• Oxford House – $500,000?
• Voices of Hope – $1 million
• Ramey Estep Homes –? $578,800
• Stable Recovery – $300,000?
• Sterling Health Solutions – $575,280
• Enrich – $595,213
• Emergency Shelter of Northern Kentucky – $320,000
• Faithlife Ministries –? $225,000
• Freedom Management Company – $500,000?
• Fresh Start Health Centers – $300,000
• Brace Community Health Center – $205,000?
• Hope for Harrison County Recovery – $123,349
• KVC Behavioral Health Care Kentucky – $400,000?
• Manchester Memorial – $250,000
• Serenity Counseling Services – $355,000
• Thrive Community Coalition –? $376,000
• The Healing PLace – $850,00
• The Jeffersontown Police Department – $26,000
• The Kentucky Center for Grieving Children and Families – $269,000
• ?Franklin County Health Department – $300,000
• Morgan’s Mission – $4,000
• The Children’s Law Center – $250,000
• Franklin County Agency for Substance Abuse Policy – $126,000
• QRT national O2SL, a Division of Homeland Security Solutions –? $750,000?
• Kentucky Health Departments Association – $1 million
• Kentucky Youth Advocates – $93,000?
• SOAR – $600,000?
• Boyd County Detention Center – $45,200
• Healing Hearts – $200,000
• Northern Kentucky Office of Drug Control Policy – $1 million

This story may be updated.?

Connie Mendel, interim chief health strategist at the Louisville Metro Department of Public Health and Wellness, spoke at the July 13 announcement that Louisville would receive $57 million from opioid settlements with drug companies. (Kentucky Lantern Photo by Sarah Ladd).

LOUISVILLE—On schedule, Kentucky’s most populous city just finalized an advisory board to oversee its opioid settlement fund distribution.?

Louisville mayor Craig Greenberg appointed health experts and other local leaders to supervise the spending of more than $57 million from opioid settlements with CVS, Walgreens, Teva and Allergan.?

Release of the? $57 million will be spread over 18 years.?

The board is responsible for reviewing grant proposals from the community on ways to address the opioid crisis and recommending winners to Metro Council.??

The members of the new Opioid Settlement Distribution Advisory Board are, according to the public health department:?

• Connie Mendel, the city’s interim chief health strategist, who will be the board chair.??
• Dr. Inder Singal, the city’s interim medical director, who will be the board co-chair.?
• Nicole George, the deputy mayor of public health and services.?
• Councilman Philip Baker
• Dr. Maryia Leyderman, licensed clinical forensic psychologist and executive administrator-chief psychologist at the Louisville Metro Department of Corrections, representing the behavioral health community.??
• Lee Zimmerman, CEO of KidzClub, focused on the needs of children, youth, and families.??
• Adria Johnson, president and CEO of Metro United Way, focused on building community resilience and addressing the root causes of substance use.?
• Mariana Barzun, executive director, Mayor’s Office of Philanthropy.??
• Barry Allen, president and treasurer of the Gheens Foundation, representing the philanthropy community.??

“The opioid epidemic has ravaged communities, families and individuals, causing widespread devastation and loss,” Greenberg said in a statement. “The settlement funds represent an opportunity to provide much-needed resources to immediately save lives, support prevention, treatment, recovery, and other critical initiatives aimed at alleviating the opioid crisis.”?

A Narcan vending machine in the exit lobby of the Louisville Metro Department of Corrections. (Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — In the two weeks after leaving jail, a person’s risk of overdosing from opioids is much higher.?

That’s because of “abstinence during the period of incarceration (and) the decrease in tolerance associated with that abstinence,” according to Ben Goldman, the community health administrator for Louisville’s public health department.?

So, the Metro Department of Corrections in downtown Louisville recently installed a vending machine in its exit lobby where people being released from jail can get free naloxone nasal spray, better known by its brand name Narcan.?

In its first three weeks, staff said Tuesday, the vending machine distributed 67 units of Narcan, which experts say can reverse overdoses and save lives.?

People exiting the jail answer a few non-name demographic questions and get the free Narcan.

The vending machine was stocked with an initial 300 units by the University of Kentucky’s HEALing Communities Study (HCS). The study is working with more than 300 agencies around the state to distribute Narcan, according to Carrie Oser, professor at the University of Kentucky and co-investigator on the HCS. Researchers and their partners have distributed some 86,000 units of Narcan.?

“We hope that other jails across the commonwealth will follow the lead of LMDC in implementing harm reduction programs,” said Oser, “such as overdose education and naloxone distribution, including implementing vending machines in (their)? institutions.”?

What is Narcan?

Narcan “knocks the opioid off of the receptor … that’s causing the respiratory collapse,” Goldman explained. “It knocks that off and blocks that receptor so that opioids can no longer bind to it.”?

The Kentucky Office of Drug Control Policy says the treatment “blocks the effects of opioids on the brain and restores breathing.”?

The Louisville vending machine is not accessible to the public. Naloxone, however, is now available over the counter at pharmacies and retails for about $45 per box, which comes with two doses.

It is free to the general public from health departments and harm reduction organizations around the state.?

How do I use it? And when?

Experts recommend people — especially those who are at higher risk of overdosing — keep Narcan on them so they can help reverse an overdose if they come across one.?

A person can’t use Narcan on themselves, but they can share it with their loved ones, who can use it to try to save them in the case of an overdose.?

Signs of an overdose include:?

• Labored breathing or not breathing at all?
• Unresponsiveness?
• Blue or gray lips or nails
• Choking or gurgling sounds?
• Pale or clammy skin?

If you think someone is overdosing, here’s what experts say to do:?

• First, call 911 so help is on the way.
• Try speaking to the person. For example, say: “I believe you might be overdosing, and I am going to administer Narcan.”?
• Take your knuckles and rake them over the person’s chest. This may also elicit a response.?
• If the person isn’t responsive, administer Narcan.?

A box of Narcan comes with user instructions, which include these rescue steps:

• Put the person on their back.?
• Tilt the person’s head back.?
• Insert the Narcan nozzle into one of the person’s nostrils.?
• Press the plunger and then remove the nozzle from the nose.?
• If the person doesn’t respond, in two minutes, repeat the process.?
• Stay with the person until emergency medical staff arrive.?

What if I gave Narcan to some someone who wasn’t really overdosing?

Some of the symptoms of overdose are shared by other conditions, which means the lay person with no medical training may mistakenly administer Narcan.?

That’s okay.??

Goldman with the Louisville Health Department said “it can’t hurt them” if given wrongly to someone.?

Worst case scenario, naloxone?can cause discomfort, but it will not cause damage.?

“When in doubt,” Goldman said, “it’s best to use it.”?

The National Library of Medicine says that making narcan and other harm reduction treatments available to more people doesn’t cause more drug use. Goldman agreed, saying that making education and Narcan available doesn’t increase use, but does decrease fatalities.?

“We must recognize that substance use and mental illness are disorders that require treatment,” said Mariya Leyderman, executive administrator and chief psychologist at LMDC. “They’re no different than diabetes or hypertension.”?

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

Twenty-three people spoke in favor of funding the development of an opioid-use disorder treatment using the psychedelic drug ibogaine with some of the state’s opoid-settlement money at the Kentucky Opioid Abatement Advisory Commission‘s second and final public hearing on Friday, Sept. 15.

Foundation for a Healthy Kentucky President and CEO Ben Chandler, a former Kentucky attorney general and five-term congressman, opened the meeting by saying that he had seen this problem from almost every angle

Chandler spoke of a first cousin’s addiction to opioids and other drugs and at least 15 failed attempts at recovery, having gone to “about every rehab center that you could go into of any note in this country.” At age 30, the cousin “put a bullet to his head” and died. “He was like a brother to me.”

Then his real remaining brother, Matthew Chandler, died of a fentanyl overdose in January. Ben Chandler said his brother sought illegal opioids to manage his pain because he wasn’t able to legally obtain the pain medications he thought he needed, and he had been addicted to opioids for “probably 15 years.”?

Chandler also talked about the surge of Oxycontin in Eastern Kentucky in the late 1990s, when he was attorney general, and his efforts to combat it, then about his time in Congress and the “enormous sums of money” spent to address this problem.??

“The bottom line to me is, despite the best efforts of so many people working on this problem for so many years — and I mean that, they work their tails off, and they care deeply — we have been unable, in my judgment, to solve this problem,” he said. “It continues to be intractable, and we need as many tools as we can get.

“And I believe that a drug like ibogaine, from what I have read, it has the potential to make the difference that we need to have made, or at least a big difference. It’s a tool that we can give the people who are working in the trenches, which will give them the opportunity, maybe, to break this cycle of addiction and actually save quite a number of lives. And I endorse anything that we can do to get that done.”

Chandler said the proposed $42 million to fund this proposal, about 5 percent of the settlements with opioid makers and distributors, “is a drop in the bucket, compared to what has been spent over the years to try to deal with this problem. And spent quite frankly, to a large extent, unsuccessfully. We have successes, but we have a whole lot of failures. And I’ve seen those failures in my family, both my cousin and my brother, in and out of facilities, strong efforts to try to break the chain of addiction, both of them no longer with us.”?

Illegal, supported by anecdotal evidence

Ibogaine is illegal in the U.S. but has been anecdotally reported to stop the withdrawal symptoms of opioid dependence. The $42 million expenditure, to help get ibogaine federal approval in the next six years, was proposed by Bryan Hubbard, chair and executive director of the commission, which operates in the office of Attorney General Daniel Cameron, the Republican nominee for governor.?

Joseph Barsuglia, a clinical psychologist and ibogaine researcher who also provided a long list of professional connections to ibogaine, talked about the first time he witnessed an opioid detoxification with ibogaine in 2015.?

“I could not believe my eyes,” he said. “To witness a patient with the most severe and chronic addiction you can imagine on death’s doorstep undergo a 48-hour process and come out calm, connected, with a new radiance in their eyes and really wanting to live — this is a miracle in the truest sense. With ibogaine, this is not a rare occurrence, this is the norm.”

Barsuglia said ibogaine works for opioid-use disorder because it “rapidly alleviates opioid withdrawal and cravings and promotes lasting sobriety in a manner that is superior to opioid-maintenance therapies,” and because “It induces dreamlike visions that increase insight into the causes of one’s addiction, which can lead to durable psychological change.”?

He said studies show that “ibogaine simultaneously targets addiction and craving to multiple substances, including alcohol, methamphetamines, cocaine and nicotine — not just opioid use disorder,” which is important because over half of opioid-use disorder patients are addicted to multiple substances.

Also, he said ibogaine is “fast acting and has durable outcomes.” He said it takes 12 months to break opioid dependence with methadone and 12 hours with ibogaine. He added, “It reduces anxiety, improves mood, does not require ongoing burden on the medical system and has little potential for abuse.”

The major objection to legalizing ibogaine are its risks to the heart. Barsuglia said that can be mitigated under a carefully controlled environment.

“I believe funding ibogaine research for opioid use disorder is perhaps one of the most obvious and necessary decisions that can be made in the history of addiction medicine,” he said.?

Personal testimonies

Several speakers gave personal testimonies about their experience with ibogaine, with a recurring message that it not only healed them physically, but also spiritually.

Paria Zandi, a licensed marriage and family therapist in California, said she describes her life as two distinct chapters, “pre-ibogaine and post-ibogaine,” and has been free of her opioid addiction for 10 years.?

“Through an intense 24-hour treatment, I emerged feeling reborn,” she said. “Not only did I escape the clutches of the physical withdrawal symptoms and cravings, but I also began to relive some of the traumas in my life and gained a newfound perspective. I saw myself as someone of immeasurable worth, and a child of God. I experienced a profound sense of aliveness and connectedness that had eluded me until that moment.”?

Zandi added that ibogaine is not a “cure-all” and if it is ever approved will need to be combined with social services, support systems and education. “We urgently need innovative approaches to addiction treatment, such as ibogaine,” she said.?

Navy SEAL veteran and ibogaine patient Tommy Aceto told the commisison, “It wasn’t just a medicinal treatment. It was a deep dive into my subconscious, self-forgiveness and most importantly, self-love.”

Reed Madison, a parent of an ibogaine patient, said of his son, “The reason he went to an ibogaine clinic is because ibogaine offered him a solution for addiction interruption without withdrawals. . . . So I feel incredibly lucky that I learned about ibogaine at the time to help give my son a way out of his addiction problem before it was too late. I think there’s a pretty good chance he may not be alive today had ibogaine not been available to him.”?

In closing, retired Marine Corps Lt. Gen. Martin Steele, CEO of Reason for Hope and the president of the Veterans Mental Health Leadership Coalition, called on the commission to vote unanimously to fund the ibogaine initiative.?

“Our nation owes its citizens a viable alternative to something that’s not working. You have it here in Kentucky, you have this moment in history, this moment in time,” he said. “To conclude, I implore each and every member of the commission to support this initiative. A unanimous vote will send a message that will resonate loudly, nationwide.”

Asked what was next, Hubbard told Kentucky Health News, “I think every commission member needs to take a little while to think over everything that they have heard. It’s a tremendous amount of information to absorb that’s been presented between May 31 and now we sit here on Sept. 15. And I think after some due diligence individually and collectively at some point, within some months, we’ll be ready to put a vote on the agenda.”

This article is republished from Kentucky Health News, ?an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

A woman enters the Great Circle drug treatment center in Salem, Ore., in March 2022. In 2020, Oregonians voted to decriminalize drugs and dedicate hundreds of millions of dollars to treatment services, but the state’s first-in-the-nation drug decriminalization has had a rocky start. (Andrew Selsky/The Associated Press)

PORTLAND, Oregon — Just before Portland’s city council approved a ban on public drug use last week, Mayor Ted Wheeler described what he’d observed on his way to work that afternoon: “The last time I saw somebody consuming what I believe to be fentanyl publicly on our streets was less than five minutes ago, three blocks from City Hall,” the Democrat said.

The Portland ban, approved unanimously but subject to legislative approval, was the latest repudiation of the state’s recent, groundbreaking approach to drug use.

Oregon voters in 2020 passed Measure 110, a first-in-the-nation law decriminalizing the possession of small amounts of controlled substances such as heroin, methamphetamines, cocaine and fentanyl.

Three years later, public drug use has wearied even the most tolerant of Oregonians. In recent months, Portland has reeled from a record number of opioid overdoses, bad press and a drop in convention and hotel bookings linked to the perception that the city is disorderly and unsafe.

Now, the Oregon law faces significant overhaul or repeal, a prospect likely to slow movements in other states to treat addiction as a public health matter, not a criminal one.

“If we don’t figure out how to get this right, efforts to try this approach in other states probably don’t launch,” said Oregon state Rep. Rob Nosse, a Democrat from Portland who worked on implementation of Measure 110 and who continues to support it.

What went wrong? A state audit found that the law’s rollout was beset by bureaucratic fumbles and a short implementation timeline; a study also has shown the measure’s civil ticketing approach had tepid law enforcement support. More critically, it coincided with a national fentanyl crisis that overwhelmed the country — not just Oregon — with a cheap, addictive and deadly drug.

The measure also took effect during a longstanding homelessness crisis in Oregon and other West Coast states that made public drug use more visible — and discomfiting — in neighborhoods where people live on the streets. It’s particularly problematic in Portland, Oregon’s biggest city, where high rates of commercial property vacancies have hollowed out some downtown sectors.

“People think that Measure 110 has been harmful to Oregon,” said pollster John Horvick of DHM Research, who conducted surveys this spring that found 6 in 10 voters think it has made drug addiction, homelessness and crime worse in Oregon. “That’s really clear. There’s no doubt that that’s where the majority of people are.”

An even more recent poll in Oregon found that 64% of voters want to repeal portions of the measure, including possibly bringing back criminal penalties for possession, and 56% support repealing it entirely. The poll, conducted by Emerson College Polling, was commissioned by the Foundation for Drug Policy Solutions, an Alexandria, Virginia-based organization that opposes decriminalization nationally.

Several rural Oregon counties, but also suburban Clackamas County adjacent to Portland, are considering non-binding advisory ballot measures during the May 2024 election to ask voters whether they think Measure 110 should be repealed.

A group of prominent civic leaders, led by the state’s former head of the Department of Corrections, Max Williams, is pressuring state lawmakers to re-criminalize possession of small amounts of controlled substances, even as they maintain funding for detox and recovery services. It’s an approach Williams and others have dubbed “amend, not end,” but it comes with an implicit threat: If the legislature fails to make timely changes to Measure 110, they’ll ask voters to repeal it in 2024.

Republican state Rep. Jeff Helfrich, a former Portland police officer, argues that without the threat of criminal conviction or prison, there’s no incentive for people with substance use disorders to stop using.

“I am all about let’s get people help, let’s get ’em what they need,” said Helfrich, who represents Hood River, a community about an hour to the east of Portland. “But you have to deter the behavior at some point. And how do you deter that behavior? That’s the million-dollar question.”

Many specialists who work in recovery, though, say reverting to a punitive system to treat addiction won’t get people sober or keep users from overdosing. That’s what they’ve learned in a decade of experience providing service to thousands of opioid users, said Joe Bazeghi, director of engagement at Recovery Works NW, which recently unveiled the first new detox center in the state to open with Measure 110 money.

The 16-bed facility in Portland is expected to serve at least 1,200 people a year, in particular those addicted to fentanyl. People can spend about five days under medically supervised detox before being offered a transition to alcohol and drug treatment and supported housing, Bazeghi said.

“What we know across the board is that when treatment is voluntarily engaged with, outcomes are better,” Bazeghi said. “And we can say that from experience, and we can say that across all our disciplines. That will be the docs, that will be the therapists, that will be the counselors, the peers, the case managers. Everybody backs that up.”

Other states reconsider

Just to the north in Washington, lawmakers this year raised the state’s penalty for drug possession to a gross misdemeanor. It’s a harsher classification than a misdemeanor, but not a felony. They also criminalized public drug use.

Both actions were in response to a 2021 Washington Supreme Court decision that found the state’s felony drug possession law unconstitutional; a temporary law passed after the ruling lowered felony offenses to misdemeanors. People found in violation while the law was a misdemeanor had to be referred twice to treatment before they could be charged with possession of a controlled substance.

The reaction to Washington’s brief experiment with lesser penalties for possession of a controlled substance proved too politically fraught, said Alison Holcomb, the director of political strategies for ACLU Washington, which supports decriminalization. Donors who had supported a statewide ballot measure similar to Oregon’s were spooked by the backlash, Holcomb said.

“The first impact that we saw was the funders, but then we also saw in the primary and general election in 2022 these narratives being leveraged by candidates,” she said. “Candidates that were looking for easy wins on 1980s, tough-on-crime, War on Drugs rhetoric, were explaining or were arguing that it would be a disaster for Washington to move in the direction of decriminalization.”

Maine lawmakers and policy experts have been watching Oregon carefully. There, the legislature considered but failed in 2021 to pass a bill similar to Oregon’s measure that would turn minor drug possession into civil fines. Winifred Tate, director of the Maine Drug Policy Lab at Colby College, said she’s hopeful discussions will continue. Maine is a small place, Tate said, with people who are committed to addressing its addiction and overdose crises.

“People know each other and have deep relationships,” she said. “That creates opportunities for political change that might be harder on a bigger scale.”

Yet many in Maine are split on whether to move forward with a health care or law enforcement approach to future drug policy. Those fissures have emerged in discussions about how to spend a $235 million settlement with the drug companies that contributed to the opioid crisis.

The quandaries are similar in California, Colorado, Massachusetts and other states considering decriminalization or other approaches aimed at reducing overdoses, including supervised injection sites. Colorado lawmakers considered but ultimately didn’t advance a bill allowing supervised drug use in some cities. And in California last year, Democratic Gov. Gavin Newsom vetoed a pilot program to reduce overdoses that would have allowed supervised injection sites.

Oregon’s path

Oregon laid out its shortcomings in a state audit released earlier this year that described the launch of Measure 110 as “beset by delays and public friction” that could have been addressed with more proactive management by the Oregon Health Authority. Oregon health officials have acknowledged they were slow to roll out the initial $300 million for Behavioral Health Resource Networks, the treatment and recovery services established in each Oregon county to help fill gaps in addiction services.

The audit also pointed out that the measure had “unrealistic timelines” for implementation. The law decriminalizing possession took effect just three months after the election, before detox and recovery networks were fully built out. It was “a very ambitious timeline,” acknowledged Kellen Russoniello, a senior policy counsel at the Drug Policy Alliance, the New York-based advocacy group behind the ballot measure.

Police in much of the state also were slow to issue civil tickets, which fine drug users up to $100 unless they call an addiction services hotline to have the penalty waived. A study conducted by researchers at Portland State University found that police are skeptical of Measure 110′s ability to motivate people to voluntarily seek treatment. As a result, they’re less willing to hand out citations, said Christopher Campbell, a co-author of the study, and an associate professor in the Department of Criminology and Criminal Justice at the school.

“We spoke to one officer from an urban sheriff’s office and they said that they believe Measure 110 took away the system’s ability to help people recognize rock bottom and kickstart a new life void of drug use,” Campbell said. “So this, along with many other reasons, leaves officers feeling like giving out that citation really isn’t worth their time.”

In 2020 when Oregon voters approved the measure, the state had the second-highest rate of substance use disorder in the nation and was ranked last in providing access to addiction treatment. Fatal overdoses were on the rise.

The status quo wasn’t working and voters knew it, said Tera Hurst, executive director of Health Justice Recovery Alliance, a coalition of organizations working to defend the new law.

“It wasn’t an accident that they overwhelmingly said: ‘No, we believe that addiction is a health care issue. We don’t want to send people to jail and we don’t want to waste our money on that, and it doesn’t work,’” Hurst said.

Hurst notes that since Measure 110 passed, thousands of people are getting help with substance use disorders. In the Portland area alone, 41 organizations received $59 million to ramp up treatment, recovery and peer support programs. Other more rural parts of the state are seeing similar levels of resources, she said, many for the first time.

“There’s more outreach, there’s more drop-in centers, there’s more housing,” Hurst said. “If you stay in the bubble of everything’s awful, you miss all the good that’s happening around.”

So far, Oregon lawmakers have resisted calls to repeal the measure, although they did pass a bipartisan law this year making it a misdemeanor to possess 1 gram or more of fentanyl or five or more pills. Other states slammed by the fentanyl crisis toughened laws around the drug, too, according to the National Conference of State Legislatures. At least 103 laws were enacted, including those that harden penalties for possession and distribution.

This fall, some Oregon lawmakers will travel overseas to Portugal to see how officials there have managed more than two decades of decriminalization. “This will give us a greater understanding of what trials and tribulations Portugal went through over their journey,” said Democratic state Sen. Floyd Prozanski, a municipal prosecutor who chairs the Senate Judiciary Committee.

Advocates continue to plead for more time, saying that such a massive societal shift in how Americans consider addiction requires more time to take hold. And no state is immune from discussions on how to address an epidemic of opioid-related deaths. Accidental overdoses are now the No. 1 cause of death for young people in 37 states.

“I’m not going to say this has been a pretty rollout,” Hurst said, “but I don’t know that I’ve ever really heard of any new, transformational law going into effect without a lot of bumps.”

This article is republished from Stateline, part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and Twitter.

Appalachian Regional Commission Co-Chairs Gayle Manchin, left, and Gov. Andy Beshear present INSPIRE award grants. (Kentucky Lantern photo by McKenna Horsley)

ASHLAND — The Appalachian Regional Commission announced nearly $14 million for projects that help people recovering from substance use disorders to re-enter the workforce.?

Across 11 states, 43 projects were selected to receive part of the funding through ARC’s? Investments Supporting Partnerships In Recovery Ecosystems (INSPIRE) Initiative. Federal Co-Chair Gayle Manchin offered her congratulations to the award winners during the commission’s annual conference which began Monday in Ashland.

“Overall, these projects will leverage partnerships and collaboration to have a regional impact for Appalachians in recovery,” she said.?

After the presentation, Manchin told reporters that the commission looks for projects that are focused not just on recovery but also beyond. Support may also come from the state and local level.?

In Kentucky, five projects will receive a portion of $1.5 million of the INSPIRE grant awards. Gov. Andy Beshear, who is the states’ co-chair on the commission, presented the commonwealth’s winners with their awards Monday.?

“This epidemic has torn at the very fabric of who we are, and everyday you are out there fighting and scratching for the inches that become the feet that become the miles of progress,” the governor said during the ceremony. “And for that, so many of our friends and family members are still alive and with us today.”?

Kentucky’s INSPIRE award winners were:?

• Southeast Kentucky Community and Technical College, which will receive almost $500,000 to create the Essential Skill HUB project to train youth ages 15-24 and support adults, people who are post-recovery and grandparents who are primary caregivers.
• Volunteers of America Mid-States, which was awarded more than $465,000 for its Recovery Reintegration program in Lincoln, Pulaski and Rockcastle counties. The initiative will give career planning, job placements with recovery-friendly employers and career advancement assistance. Goodwill Industries of Kentucky, Daniel Boone Community Action Agency and Kentucky Chamber Foundation are partners on the project.
• Love Must Win was awarded $50,000 for its Elemental Recovery Program, which will conduct a community assessment on service gaps and create a plan. Love Must Win will partner with other organizations, including Eastern Kentucky Recovery, New Vista, Kentucky River Foothills, the Kentucky Community & Technical College System, Eastern Kentucky University, Berea College and Kentucky Rural Health Association.
• Morehead State University will receive $50,000 for a project called Bettering Outcomes for the Second-Chance Employment: Creating Future Success for Employers and Employees. The project will include a research study and assessment of training, employment support and future hiring needs of businesses across five counties while collecting data from people who are in recovery, are formerly incarcerated or are experiencing long-term unemployment. Partners on this project are Northeast Kentucky Area Health Education Center, Gateway Area Development District and the Morehead-Rowan County Chamber of Commerce.
• The Thrive Community Coalition was awarded $500,000 for a project in Inez called Come Alive: Nurturing Recovery Through Training and Employment. Using an existing program with the Martin County court system prosecutor’s office, people who are near completing a residential treatment program or enrolled in an outpatient program will be referred to the Come Alive program which will offer services like peer mentoring, assessment and job training. Partnerships with local businesses will also be developed with the help of an employer liaison.

Photos of young overdose victims on display at an overdose awareness event in Rockville, Maryland, in August. Accidental overdose has become a primary cause of deaths for people under 40. (Photo by Tim Henderson/Stateline)

A new Stateline analysis shows that U.S. residents under 40 were relatively unscathed by COVID-19 in the pandemic but fell victim to another killer: accidental drug overdose deaths.

Death rates in the age group were up by nearly a third in 2021 over 2018, and last year were still 21% higher.

COVID-19 was a small part of the increase, causing about 23,000 deaths total between 2018 and 2022 in the age group, which includes the millennial generation (born starting in the early 1980s), Generation Z (born starting in the late ’90s) and children. Vehicle accidents and suicide (about 96,000 each) and gun homicide (about 65,000) all took a cumulative toll from 2018 to 2022, according to a Stateline analysis of federal Centers for Disease Control and Prevention data.

Overdose deaths, however, took almost 177,000 lives in that time.

Accidental overdose became the No. 1 cause of death in 13 states for people under 40, overtaking suicide in nine states and vehicle accidents in five others; it’s now the top cause in 37 states, including Kentucky. The only other change was in Mississippi, where homicide became the main cause of death, overtaking car accidents. In 40 states and the District of Columbia, overdose was the biggest increase in deaths for young people.

States are responding to the skyrocketing death rates with “harm reduction” strategies that can include warning of the new danger of recreational drugs laced with deadly fentanyl, training and equipping people to counteract overdoses when they see them, and even considering controversial supervised drug use sites to keep addicts safer.

A “fourth great wave” of accidental overdose deaths driven by drugs spiked with powerful fentanyl is now washing over young America, said Daliah Heller, vice president of drug use initiatives at Vital Strategies, an international advocacy group that works on strengthening public health.

Prescription opioids led to one surge in drug dependency from 2000 to 2016, then when supply waned in response to crackdowns, users turned to heroin, synthetic opioids and finally fentanyl, which is 50 times more potent than heroin and easier to get in the pandemic, Heller said.

‘Very common’ experience

Jonathan Diehl of Silver Spring, Maryland, died in 2019 at age 28 after using heroin he likely did not know was spiked with fentanyl, said his mother, Cristina Rabadán-Diehl. Jonathan Diehl earned a degree in construction management and was starting a promising new job in home heating and air conditioning four days before he died, his mother said.

“I think Jonathan’s trajectory was very common,” said Rabadán-Diehl, who now works as an adviser on substance use disorders. “He started with opioid pills, and when the government started putting restrictions on prescriptions, he as well as millions and millions of Americans transitioned into the illegal market. And then fentanyl made its appearance.”

Now, a fresh wave of overdose deaths — different from the first three — is fed by fentanyl making its way into all kind of recreational drugs, and by pandemic isolation that led to more solitary drug use, Heller said.

“Somebody might think they’re getting a Xanax [for anxiety], or methamphetamine or cocaine,” Heller said. “They have no experience with opioids, it’s not what they’re expecting and now they have a much higher risk of overdose and death.”

Authorities generally classify overdose deaths as an accident or suicide based on individual investigations of the circumstances surrounding each death.

States struggling the most with deaths of young people, driven mostly by accidental overdoses, include New Mexico, which eclipsed West Virginia and Mississippi since 2018 to have the highest death rate in the nation for people under 40 — about 188 deaths per 100,000, up 43% since 2018.

Other states with high death rates for the age group include West Virginia (170 deaths per 100,000), Louisiana and Mississippi (164), and Alaska (163).

In Kentucky, the death rate for people under 40 was 142.3 per 100,000. Drug overdose was the leading cause of death among Kentuckians in this age group in 2018 and 2022. Among all age groups last year in Kentucky, fatal overdoses ticked down 5% from 2,250 deaths in 2021 to 2,135 in 2022, according to the state. It was the first decrease in overdose deaths since 2018.

In New Mexico, where accidental overdoses became the main cause of death for people under 40 in 2022, overtaking suicide and rising 90% to 394 deaths since 2018, the overdose problem has generally been concentrated in poverty-plagued rural areas such as Rio Arriba County on the Colorado border.

Democratic state Rep. Tara Lujan, who has relatives in that county, sponsored harm reduction legislation signed into law last year. It is similar to laws in many other states that include wide distribution of naloxone to reverse overdoses, legalized testing equipment for deadly additives like fentanyl, and good Samaritan laws that allow friends to report overdoses without legal consequences for their own drug use.

Lujan hopes to reintroduce a bill that would create so-called overdose prevention centers or harm reduction centers where drugs can be used in a supervised and safe environment. The legislation died in committee this year after Republicans called the idea “state-sponsored drug dens.”

“It’s all issues that were in place before the pandemic, but the pandemic made everything completely off the rails,” Lujan said. “My committee meetings have been packed with family members saying, ‘We know they won’t quit on their own, but we don’t want them to die.’”

Only New York City has two such facilities in operation, run by advocates; the sites claim some success in reversing overdoses. But federal law enforcement authorities are threatening to shut them down without a specific state mandate, since otherwise they fall under a federal law banning operations that allow illegal drug use on-site.

In California, Democratic Gov. Gavin Newsom last year vetoed legislation that would have allowed jurisdictions to open safe injection sites, saying they “could induce a world of unintended consequences” in cities such as Los Angeles, San Francisco and Oakland.

“Worsening drug consumption challenges in these areas is not a risk we can take,” Newsom wrote in a veto message.

Rhode Island is the only state so far to pass legislation allowing supervised drug-use sites as a pilot project, in 2021, but has yet to open any centers. New legislation introduced this year would push the expiration of the pilot project from 2024 to 2026.

Bills on the same topic of supervised drug-use sites were under consideration this year in Colorado, Illinois and New York but did not pass.

In a sign of the impact on young people, a Massachusetts bill would have required all state university dorm assistants to have naloxone training to reverse overdoses, but it stalled.

New Hampshire is one of several states experimenting with vans that go to known drug-use locations and offer overdose prevention supplies and advice.

Death rate disparities

The lowest death rates for young people in 2022 were in Hawaii (78 deaths per 100,000), Massachusetts and Rhode Island (79), and Utah and New Jersey (80). Massachusetts and New Jersey were the only states to see decreases in overall deaths for people under 40 since 2018, and also had drops in overdose deaths, although overdose remained the No. 1 cause of death for young people in both states.

Nationally, accidental overdoses dominated the increase in deaths in residents under 40 across racial and urban-rural divides, but many disparities exist. The increase in young overdose death rates was 154% for Black Americans, 122% for Hispanic residents and 37% for white people, yet even for white residents they represented the largest increase.

The largest urban areas saw increases in overdose death rates of 70%, and rural areas 64% — the largest increases in both areas for any cause of death.

Across races and age groups overdose death rates are higher for men and slowed in 2017, but picked up again after 2018 and skyrocketed in the pandemic until 2021, according to a federal National Center for Health Statistics data brief published last year.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and Twitter.

Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

Kentucky has added two new syringe-service programs for intravenous drug users this year, bringing the total to 84 SSPs, in 65 of the state’s 120 counties. Hart County opened its program in January and Estill County reopened its program in April.

SSPs are part of what health departments call “harm reduction”? — programs that offer a host of strategies to minimize the negative physical and social impacts of drug use. They are also called syringe-exchange programs, or needle exchanges, for the best-known element of the prorgams.

Estill County’s program reopened after being shut down in 2020 because the Irvine City Council took away its approval, required by state law in a city where a program is based. The Estill County Health Department’s program is now in a mobile clinic that goes to multiple locations in the east-central Kentucky county.

Hart County is in south-central Kentucky, which is served by the Barren River District Health Department. Charity Crowe, a UK Healthcare health-education coordinator embedded in the department’s harm-reduction program, told Kentucky Health News that adding more SSPs to decrease overdose deaths is one goal of the Barren River Initiative to Get Healthy Together (BRIGHT) Coalition.

Only three of the eight counties in the district have SSPs. Warren County opened its program in 2016, Barren County in 2018, and Hart County in January.

Crowe said one of the first steps they took as they worked to get local approvals in Hart County was a survey of local jail inmates, asking f they would use an SSP if it was available. She said 63 inmates, or 64% of the survey respondents, said they would use it.

“That kind of helped us with getting everything passed through the Board of Health, Fiscal Court and City Council,” Crowe said. She praised the efforts of County Judge-Executive Joe Choate: “He was a huge supporter of the program and us getting it started, so that helped get everything moving along a lot quicker.”

Asked if she had any advice for people in the 55 Kentucky counties that still don’t have an SSP, but want one, she said it’s important to keep educating people about what they are and why they are important.

“Just to try to educate people on why we do what we do,” Crowe said. “There’s so much stigma surrounding the things that we do with harm reduction. … We are trying to make our communities a safer place, not just for people that use drugs, but for our kids, our first responders, everybody.”

She also encouraged them to not give up. “Pretty much anywhere that you go, you will get a little bit of pushback,” she said. “But in order for us to break that stigma, we just have to keep educating people.”

Looking to other counties in the district, Crowe said they have held an educational meeting in Edmonson County and are working to have one in Logan County. She said Logan County’s health board and Russellville City Council have approved an exchange, but the Fiscal Court has not.

Syringe-service programs not only exchange clean needles for dirty ones, to decrease the spread of blood-borne diseases like hepatitis C and HIV, but provide education on the safe use and distribution of wound-care kits and Naloxone, which blocks a drug overdose. Other services are infectious-disease screening, vaccinations, and linking people to housing, food access, insurance, medical care, substance-use treatment and behavioral-health services.

Crowe said the SSPs in Hart and Warren counties also use a peer-support specialist who has “been a phenomenal resource for our clients.”

On June 29, a new law kicked in that decriminalized fentanyl test strips in Kentucky, meaning they will no longer be considered drug paraphernalia. Because of this, Kentucky’s SSPs can offer them to their clients . Fentanyl was involved in 72.5% of the state’s 2,135 overdose deaths in 2022.

Fentanyl test strips are paper strips that can detect the presence of the powerful opioid in pills and other drugs within minutes. They are considered a low-cost method of helping prevent drug overdoses and reducing harm, according to the Centers for Drug Control and Prevention.

This article?is republished from Kentucky Health News, an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

A molecule of ibogaine, a monoterpenoid indole alkaloid and psychoactive substance derived from the root of an African shrub. Anecdotal evidence suggests it relieves opioid withdrawal syndrome. (Getty Images)

Ibogaine is a powerful psychedelic that comes from a plant mainly found in Africa. It is illegal in the U.S. but has been reported to stop withdrawal symptoms of opioid dependence but also cause heart problems.

Pharmacist lawmaker wants discussion

Hubbard, the commission’s chairman, cut off discussion after Rep. Danny Bentley, who joined the meeting virtually, asked when the panel would be able to discuss the idea. State Health and Family Services Secretary Eric Friedlander also voiced concern that there was no discussion by the panel before Hubbard announced the plan May 31.

Bentley, a pharmacist and a Republican from Russell in Greenup County, said, “I think we should discuss it today.” Hubbard replied, “The motion on the floor is to adopt the public hearing schedule and that is what the discussion will be centered around.”

Friedlander and another commission member appointed by Democratic Gov. Andy Beshear learned about the ibogaine idea only when Hubbard revealed it at an event hosted by his boss, AG Cameron, the Republican nominee against Beshear in the fall election, Beshear said last month.

Hubbard said May 31 that the commission would “explore the possibility” of committing “no less than $42 million” to developing the treatment of ibogaine for opioid-use disorder, with a goal of getting it approved within six years from the U.S. Food and Drug Administration.

Hubbard took a few minutes to address what he said were misunderstandings. He said no funds have been allocated. “At this stage in the game, the only thing that we aim to do is to explore the possibilities related to ibogaine, its applicability as a therapeutic to opioid-use disorder,” he said. “And then the second question is whether and to what extent this commission would commit funds to help develop Ibogaine as a therapeutic to go through the FDA approval process. We’re a good bit away from answering that question.”

Sharon Walsh of the University of Kentucky, who oversees a multi-year, interventional research project to find tools for preventing and treating opioid addiction, with federal funding of $87 million, voiced several concerns.

Conflict of interest concern

Walsh asked how the settlement money could be used to explore a drug that has not been approved by the FDA because the commission’s guiding law clearly says that the money must be used on evidence-based pursuits.

There’s a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market. That’s why I’m asking for balance.

– Sharon Walsh, director of the University of Kentucky Center on Drug and Alcohol Research

Hubbard said the law includes language that would support this effort “insofar as it recognizes that the commission may allocate resources for any projects it deems appropriate.” Further, he said, “We are well within our legal ability to explore. . . and that’s the only thing we’re seeking to do here.”

Walsh also pointed out that there are mixed opinions about the use of ibogaine for opioid-use disorder. She asked if there would be “point-counterpoint” participants at the public hearing, or if it would only be people who are trying to develop it.

Hubbard said at least two subject-matter experts will be invited to the first public hearing, including Deborah Mash, founder and CEO of DemeRx, a pharmaceutical company developing ibogaine for treating addiction. He told Walsh that if she had an expert she would like to invite, they would work to include them.

Friedlander asked if the focus could be broadened to include other psychedelics, but Hubbard said that wasn’t possible, because while other psychedelic drugs are closer to FDA approval, they don’t appear to be as effective against opioid withdrawal syndrome, as ibogaine may be.

Walsh pushed back: “If the focus is on opioid withdrawal, we have medications that are already approved for opioid withdrawal. It’s not something that is difficult to manage clinically. And there are protocols that have been in place for 30-some years. . . .?Those are very effective drugs. I’m not sure why we need other drugs to target opiate withdrawal.”

Hubbard replied, “Well, there are others who would seem to believe that this is worth exploring”? and that it has “breakthrough therapy potential. I want to know if that’s true, right? And that’s why we’re having this exploration.”

Walsh also noted that she has known the proposed witness, Mash, for 30-some years and that Mash has been working on ibogaine since the 1990s.

“She’s the CEO of a company that’s trying to develop it. So she’s going to come and talk to us about the development of this with it, you know, with the hope of getting money. There’s a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market,” Walsh said. “That’s why I’m asking for balance.”

Hubbard replied, “Insofar as there are individuals who you know, with expert credentials that offer alternative views, please share those with the commission staff and myself.”

Bags of heroin, some laced with fentanyl, displayed after a drug bust in New York. (Photo by Drew Angerer/Getty Images)

Kentucky’s 2022 Overdose Fatality Report, released Thursday, shows the commonwealth saw its first decline in fatal overdoses since 2018.?

Still, 2,135 Kentuckians died from an overdose in 2022. Ninety percent of those deaths were from opioids and fentanyl. Potent inexpensive methamphetamines also continue to be a driving factor.??

During his weekly press conference Thursday, Gov. Andy Beshear said most Kentuckians, including himself, have lost someone to the ongoing national opioid crisis.?

While that loss is tough, Beshear said there was some hope in the report. Kentucky was one of eight states that saw a significant decrease last year in overdose deaths by a percent less than the year before. (Preliminary numbers on fatal overdoses were released in April.)

“Seeing our first decrease in overdose deaths, and being one of the few states despite the fact that the nation is up in overdose deaths, means we have a whole lot of people working incredibly hard doing selfless, amazing work,” Beshear said. “And to see this decrease at a time when the drugs are more potent than ever before and can cause overdoses that much easier means our Kentuckians out there trying to help one another are going above and beyond.”?

The governor thanked law enforcement officials for working to intercept fentanyl and those who provide treatment and work in recovery. Kentucky has seen a 50% increase in treatment beds since Beshear became governor, he said.?

The Office of Drug Control Policy is expected to award $80.6 million to support addiction treatment and prevention efforts across the state.?

Van Ingram, the director of the office, said Thursday that while the state is excited about the reduction in fatal overdoses, “there’s so much more work to be done, and we’re committed to doing it as well.”?

Ingram applauded recent legislation signed by Beshear, House Bill 353, that removes fentanyl test strips from being classified as drug paraphernalia. Fentanyl isn’t being sold on its own, he said. Some substances, like Percocet, Xanax and Adderall, are being laced with it.??

Later this year, the Office of Drug Control Policy will have an education awareness campaign with the Division of Behavioral Health.?

Tara Moseley Hyde, CEO of People Advocating Recovery, said the organization supports more resources across the state, such as the new classification for the testing strips and expanding access to naloxone or Narcan, a drug that can reverse an opioid overdose. She said more collaborations across communities can support Kentuckians in recovery.?

“I think that we’re in the right direction, and we need to stay the course and continue to expand,” Hyde said. “And we’re on our way.”??

Another resource, www.findrecoveryhousingnowky.org, has been visited more than 17,000 times, Beshear said. The website aids persons who have come out of treatment but continue to need a stable environment. One hundred-eighty-one homes are listed on the site.?

“We are encouraged that drug overdose deaths in Kentucky seem to be trending downward. However, one life lost to an overdose is still too many,” Matt Brown, the Chief Administration Officer of Addiction Recovery Care (ARC), said after the report came out. “Drug overdose fatalities still remain above pre-pandemic levels, but having been on the frontlines of this crisis for many years, we have a blueprint for what works. We must continue to bolster our treatment and recovery infrastructure and ensure all Kentuckians can access the comprehensive services they need for long-term recovery.”

In February, ARC announced it would open a new treatment center in Greenup County in late 2023 or early 2024 inside a former hospital.?

Also, in January, Volunteers of America announced it would both expand its substance abuse recovery program and a long term study to look at its effects and success thanks to $1.3 million in donations.?

“There has never been a more dangerous and deadly time to be using drugs or living with a substance use disorder,” Brown said. “People need to know that treatment is available, and recovery is possible. We will continue to do everything we can to spread that message and get people the help they need, as soon as they need it.”

Wendy Peay, secretary of the Greene County Anti-Drug Coalition, said the group focuses on prevention work with kids because “we can change the trajectory of their lives as adults.” (Wendy Peay/Greene County Anti-Drug Coalition)

Over the past two years, rural Greene County in northeastern Tennessee has collected more than $2.7 million from regional and national settlements with opioid manufacturers and distributors. But instead of helping people harmed by addiction, county officials are finding other ways to spend it.

They have put $2.4 million toward paying off the county’s debt and have directed another $1 million arriving over more than a decade into a capital projects fund. In March, they appropriated $50,000 from that fund to buy a “litter crew vehicle” — a pickup truck to drive inmates to collect trash along county roads.

“It’s astounding,” said Nancy Schneck, a retired nurse who has seen addiction infiltrate the community, where employers avoid drug testing for fear of losing too many employees and mental health crises and homelessness are rampant. She wants to see the money go toward mental health and addiction treatment. Why can’t county leaders “see treating some people and maybe getting them out of this cycle might be advantageous?” she said.

In 2021, the latest year for which comparable data is available, Greene County’s rate of drug overdose deaths topped state and national figures.

But Mayor Kevin Morrison said the county has borne the costs of the opioid epidemic for years: It has funded a beleaguered sheriff’s office, improved the jail — which is packed with people who’ve committed addiction-related crimes — and supported a drug court to divert some people to treatment. It has also suffered indirect costs of the crisis: people dropping out of the workforce due to addiction, schools and welfare services caring for more children who’ve experienced trauma, and some taxpayers leaving the county altogether. Addiction is not the sole reason for Greene County’s economic woes, but it has contributed to more than $30 million of debt.

“We’ve been dealing with this crisis for quite some time, but nobody wants to pay the bill as it comes,” Morrison said. “So when these funds are made available, then we are paying bills that have been due for quite some time.”

The debate in this Appalachian county is reverberating nationwide as state and local governments receive billions of dollars from companies that made, distributed, or sold opioid painkillers, like Johnson & Johnson, Cardinal Health, and CVS. The companies were accused of fueling the overdose epidemic, and the money is meant to remediate that harm. About $3 billion has already landed in state, county, and city coffers, and about $50 billion more is expected in the coming decade and beyond.

States are required to spend at least 85% of the money on opioid-related programs, but KFF Health News’ ongoing investigation into how the cash is used — and misused — shows there is wide interpretation of that standard and little oversight.

That restriction didn’t apply to the money Greene County moved to its capital projects fund.

In many rural communities, which have been struggling to pay addiction-related costs for decades, local officials justify using the settlement funds to reimburse past expenses. Most of Tennessee’s 95 counties are in significant debt, which can present difficult choices about how to use this money, said Robert Pack, co-director of East Tennessee State University’s Addiction Science Center.

Still, he and many advocates hope the settlement funds are spent on tackling the current crisis. After all, more than 200 people nationwide are dying of overdoses each day. Investing in treatment and prevention can save lives and protect future generations, they say.

“There is no good excuse to sit on the funds or put them into a general fund,” said Tricia Christensen, policy director for the nonprofit Community Education Group. The organization is tracking settlement spending across Appalachia, which Christensen called the epidemic’s ground zero. “These dollars should be used to support people who have been most impacted by the overdose crisis.”

Nationally, there has been little oversight of the settlement dollars. President Joe Biden’s administration pledged to ensure the funds went toward tackling the addiction crisis, but has taken little action. Accountability at the state level varies.

In Tennessee, 15% of the state’s opioid settlement funds are controlled by the legislature and another 15% by local governments. Those two buckets have few restrictions.

The other 70% is controlled by an Opioid Abatement Council, which has more rigorous standards. When the council, which must give 35% of its funds to local governments, recently distributed more than $31 million to counties, it required the funds be spent on a list of approved interventions, such as building recovery housing and increasing addiction treatment for uninsured people.

“I can guarantee we’re going to bird-dog” those funds, said Stephen Loyd, chair of the council and a physician in recovery from opioid addiction. If counties use them for unapproved purposes, the counties will not receive future payouts, he said.

Greene County’s reimbursement of its capital projects fund comes from its own pot — the 15% that is controlled entirely by local governments.

In such cases, the public can hold officials accountable, Loyd said. “If you don’t like the way the money is being spent, you have the ability to vote.”

Local leaders are generally not being “nefarious” with these decisions, he said. They make hundreds of budgetary choices a month and simply don’t have experience with addiction or health policy to guide them in using the money.

Loyd and other local experts are trying to fill that gap. He meets with county officials and recommends they speak with their local anti-drug coalitions or hold listening sessions to hear from community members. Pack, from East Tennessee State, urges them to increase access to medications that have proven effective in treating opioid addiction.

Both men point counties to an online recovery ecosystem index, where leaders can see how their area’s resources for recovery compare with those of others.

In Greene County, for example, the index indicates there are no recovery residences and the number of treatment facilities and mental health providers per 100,000 residents is below state and national averages.

“That’s a great place to get started,” Loyd said.

Some Greene County residents want to see opioid settlement funds go to local initiatives that are already operating on the ground. The Greene County Anti-Drug Coalition, for instance, hosts presentations to educate young people and their parents on the risks of drug use. They meet with convenience store owners to reinforce the importance of not selling alcohol, cigarettes, or vaping devices to minors. In the future, the coalition hopes to offer classes on life skills, such as how to budget and make decisions under pressure.

“If we can do prevention work with kids, we can change the trajectory of their lives as adults,” said Wendy Peay, secretary of the anti-drug coalition and executive director of United Way of Greene County.

The coalition has asked the county for settlement funds but has not received any yet.

Nearby in Carter County, a new residential treatment facility is taking shape at the site of a former prison. At least seven counties, cities, and towns in the region have committed a combined $10 million in opioid settlement funds to support it, said Stacy Street, a criminal court judge who came up with the idea. Greene County is among the few local governments that did not contribute.

It will be part of the region’s drug recovery court system, in which people with addiction who have committed crimes are diverted to intensive treatment instead of prison.

Currently there are no long-term residential facilities in the area for such patients, Street said. Too often, people in his court receive treatment during the day but return home at night to “the same sandbox, playing with the same sand-mates,” increasing their risk of relapse.

Street said the new facility will not offer medications to treat opioid addiction — the gold standard of medical care — because of security concerns. But some patients may be taken to receive them off campus.

Morrison, the Greene County mayor, said he worried about contributing to the facility because it is a recurring cost and the settlement funds will stop flowing in 2038.

“There’s been great pressure put on local entities like Greene County to try to solve this problem with this limited amount of funding,” he said, when “the federal government, which has the ability to print money to solve these problems, is not in this business.”

The county is still deciding how to spend nearly $334,000 of settlement funds it recently received from the state’s Opioid Abatement Council. Morrison said they’re considering using it for the anti-drug coalition’s education efforts and the county drug court. Given the guidelines from the abatement council, these funds can’t be used to pay old debts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Deb and Ray Cullen, of Shippingport, Pa., center and right, show a photo of their son, Zachary, in the office of their congressman, GOP Rep. John Joyce, left. Zachary died nine months ago at 23 after ingesting cocaine laced with illicit fentanyl. The Cullens traveled to the U.S. Capitol Thursday, May 25, to watch the House vote on the HALT Fentanyl Act. Ashley Murray/States Newsroom

WASHINGTON — Lawmakers in the U.S. House passed bipartisan legislation Thursday in an effort to curb staggering overdose deaths from illegal fentanyl substances that are illicitly produced and up to 50 times stronger than heroin.

The HALT Fentanyl Act, passed on a 289-133 vote with 74 Democratic votes and support from the Biden administration, would permanently categorize lab-made substances with similar chemical structures to fentanyl among the most strictly regulated drugs under U.S. law.

The Drug Enforcement Administration in 2015 temporarily defined 17 fentanyl-related substances as Schedule I — the category carrying the most severe criminal penalties. Congress has since extended the temporary scheduling multiple times.

While proponents who point to record-breaking overdose deaths say the legislation would hold traffickers accountable, numerous advocacy groups argue the bill is under researched and risks criminal charges for those in possession of small amounts of “harmless and inert substances,” according to a letter signed by 150 organizations.

Drug overdose rates in the U.S. have risen fivefold in the past two decades, according to a Centers for Disease Control and Prevention study published in December.

The study shows that deaths attributed to synthetic opioids, including fentanyl and its many analogues, have been steadily on the rise, with a staggering jump in recent years.

The CDC tracked a record 107,622 overdose deaths in 2021 — 71,238 of them due to manmade, illegal fentanyl substances.

The DEA attributes more deaths to illegal fentanyl among Americans under 50 than any cause of death, including heart disease, cancer, homicide, suicide and other accidents.

Of particular concern is that illicit fentanyl substances are often cut into other recreational drugs, including cocaine, methamphetamine and heroin, with users unaware of its presence.

“The HALT Fentanyl Act would ban fentanyl analogues and strip the drug cartels and other criminals of the incentive to create new versions of fentanyl to skirt around the law,” GOP Rep. Brett Guthrie of Kentucky said on the House floor late Wednesday. “This bill is a key step to help get these poisons off our streets and give law enforcement the tools they need to crack down on illicit fentanyl traffic trafficking.”

Effect on loved ones

Sunday will mark nine months since Deb and Ray Cullen, of Shippingport, Pennsylvania, lost their 23-year-old son Zachary to fentanyl poisoning.

The Shippensburg University student had traveled with two friends to Harrisburg for a birthday weekend trip.

“They were having dinner, having drinks, enjoying themselves. And then at some point, the detective told us that he thinks that they were targeted by a dealer. He doesn’t think they were looking for anything but thinks somebody came up to them and offered, and they made the choice to purchase some cocaine. And the cocaine was laced with fentanyl,” Deb said.

The morning they received the news, Ray and Deb say, they turned on Zachary’s laptop to find that he had left open study materials for his university course in managerial economics.

“He passed away. His friend survived, but with some physical issues. So we’re here trying to just make a difference so that other families don’t have to go through this,” she said Thursday shortly after the vote while sitting in the office of GOP Rep. John Joyce, her representative and a co-sponsor of the bill.

The parents said they hope to see more awareness and an end to the stigma around those with substance use disorder and those who experiment with drugs that they are unaware are laced with illicit fentanyl.

“There’s a lot of recreational cocaine and drug use. There was (someone yesterday) who said that had (the users) not done something illegal, that they would still be here,” Ray said. “I’m like, ‘Well, there’s a lot of things that get done illegally that you don’t die from.’”

“I think people that are dealing this drug, they need to be held accountable,” Deb added.

Joyce said he has been following up with the family since they emailed his office shortly after their son’s death.

“I went over to Speaker McCarthy (today) and said ‘Up there in the gallery, there are parents who have lost their son, and they’re courageous and they continue to work to spread this message and have taken time out of their busy lives to come to Washington and drive down here for this vote,’” Joyce said.

“This is an initial step. We need to take additional steps to (go after) the active ingredients which are shipped from China, to Mexico to the cartels, formulated and brought through our borders to kill our family or neighbors or friends,” Joyce continued.

Unlike legal fentanyl that doctors prescribe after surgery or for advanced stage cancer patients, illicit fentanyl and fentanyl-related substances are produced in underground labs by transnational criminal organizations.

Concerns over mandatory minimums

More than 150 harm reduction, criminal justice and civil liberties organizations have come out against the bill, which was introduced this Congress by GOP Reps. Morgan Griffith of Virginia and Robert Latta of Ohio.

In a letter Wednesday to House leadership, groups including the American Civil Liberties Union and Human Rights Watch urged lawmakers to vote against the legislation.

“The classwide scheduling policy expands the application of existing severe mandatory minimum sentencing laws enacted by Congress in the 1980s to a newly scheduled class of fentanyl-related compounds,” the letter said. “For example, just a trace amount of a fentanyl analogue in a mixture with a combined weight of 10 grams — 10 paper clips — can translate into a five-year mandatory minimum with no evidence needed that the seller even knew it contained fentanyl.”

Other advocacy groups who co-signed the letter included the Association of Black Social Workers in Virginia, the Florida Harm Reduction Collective, Progressive Maryland and HEAL Ohio.

Though the bill outlines registration processes for researchers to continue to test the fentanyl-related substances, the advocacy groups say that lawmakers are classifying chemical compounds before their effects are known.

“… the HALT Fentanyl Act does not include an offramp to reschedule or remove (fentanyl related substances) that research has proven to be pharmacologically inactive or do not meet schedule I criteria,” the letter continues.

Criteria used by the Department of Justice to classify Schedule I drugs include high abuse potential and “no currently accepted medical use in the United States.”

Marijuana, LSD, ecstasy and peyote are listed as Schedule I.

“In committee, Democrats offered amendments to improve the (bill),” Rep. Frank Pallone of New Jersey said on the House floor Wednesday. “We asked that Republicans consider additions to the bill that reflect the Biden administration’s commonsense interagency proposal.”

Pallone, ranking member of the House Committee on Energy and Commerce Committee, which marked up the bill, said the amendments rejected by GOP leadership would have promised “a scientific and equitable approach.”

Support from across the aisle

Despite the opposition from many Democrats, 74 of the party members voted in favor of the HALT Fentanyl Act.

“To stop this effort now is just not right. Fentanyl related substances are highly toxic and we should treat them as such with blanket permanent scheduling,” said Rep. Chris Pappas of New Hampshire.

Pappas is the sponsor of a bill that permanently schedules fentanyl related substances but also adjusts criminal penalties and establishes a process to declassify compounds found to be safe.

“This is the beginning of the legislative process. This bill … would likely come back to the House after the Senate puts its mark on it. So we’re going to continue to advocate for those commonsense provisions,” Pappas said.

The Biden administration issued a statement earlier this week supporting the HALT Fentanyl Act but said that its other recommendations to lawmakers included compelling agencies to root out which substances do not pose high potential for abuse and to study the effects of the blanket scheduling.

“The Administration calls on Congress to pass all of these critical measures to improve public safety and save lives,” the statement said.

Syringe exchanges provide intravenous drug users with clean needles to prevent the spread of bloodborne diseases like HIV and hepatitis. (Getty Images)

Beshear cited preliminary numbers from the Kentucky Injury Prevention and Research Center, which showed 2,127 overdose deaths in 2022, down from 2,257 in 2021.?

“That number is still far too high,” Beshear said. “One is too many.” But, he said, it’s still encouraging to have the number drop for the first time in years.?

Center for Disease Control and Prevention data shows fatal drug overdoses haven’t dropped in Kentucky since 2018.?

“I certainly hope that the medical marijuana program. or what’s allowed under my executive order, is resulting in fewer people having to take opioids,” Beshear said. “What we know is that opioids are so addictive, and so it would stand to reason that if we cut down the number of people who ever start taking them, then we would cut down at least a portion of the addiction that’s out there.”?

Opioids, according to the CDC, are a class of pain medication, which may include oxycodone, hydrocodone, morphine and methadone.?

Recent years have also seen a rise in deaths from the synthetic opioid fentanyl. The powerful drug contributed to 73% of Kentucky’s overdoses in 2021. A new Kentucky law decriminalized fentanyl test strips, which can detect the presence of fentanyl in pills and other drugs within minutes. Experts have said such a test can save lives.?

In late March Beshear signed bipartisan legislation legalizing medical marijuana – with restrictions. That came after he signed an executive order in late 2022 that said, starting Jan. 1, people with illnesses like cancer, multiple sclerosis and post-traumatic stress disorder could get access to no more than eight ounces of medical cannabis purchased in the United States.?

He said Thursday he hopes steps to legalize marijuana will help people who otherwise might turn to opioids.?

“If we can take another step to decrease people’s uses of opioids,” Beshear said, “if they can treat pain instead with medical marijuana…I do believe that it will result in fewer opioid deaths.”?

Dana Quesinberry with the Kentucky Drug Overdose Data to Action said the “early signal” of death decline is a positive thing, but there is more work to do.?

“While this news is encouraging, there’s still a lot of work to be done,” she said. “And we really hope that this early signal will…strengthen our resolve to address substance use issues, including the diagnosis and treatment of substance use disorders and continue to support Kentuckians…in their recovery and our joint recovery as we move forward.”?

Gov. Andy Beshear, seated, shows his signature on Senate Bill 47 to Sen. Steve West. (Photo for Kentucky Lantern by McKenna Horsley)

FRANKFORT — Democratic Gov. Andy Beshear called Friday an “amazing” day as he signed two pieces of legislation — legalizing medical marijuana and sports betting — that were passed by the Republican-controlled General Assembly.?

With legislative sponsors and advocates gathered around him in the Capitol Rotunda, Beshear signed Senate Bill 47 and House Bill 551. Both bills received their final floor votes Thursday night, the last time lawmakers met before adjourning until next January.?

Beshear told reporters after signing the bills that the bipartisanship behind the legislation was clear and showed that his administration can work with the General Assembly.?

“Today’s pretty amazing. We passed two pieces of legislation that took both Democrats and Republicans — would not have passed without them — people coming together to do what’s right for the people of Kentucky,” the governor said.?

The medical marijuana law does not go into effect until 2025 to give the Cabinet for Health and Family Services time to establish regulations and licensing. Kentucky will be joining 37 other states in legalizing medical marijuana. Next session, lawmakers are expected to debate amendments to the new law.?

Beshear thanked bill sponsors as well as advocates for medical marijuana, as they “have made the difference” in generating support for the legislation by sharing their stories. Beshear at the start of the year signed an executive order to set criteria for Kentuckians with certain medical conditions to access medical cannabis in small amounts.

Legalization came after about five years of “a hard-fought legislative effort,” the bill’s primary sponsor, Sen. Stephen West, R-Paris, said on Friday.

West thanked two of his constituents, Eric and Michelle Crawford, vocal proponents for the legalization of medical marijuana. Eric told a House committee on Thursday cannabis made him “comfortable” after living with injuries from a car crash more than two decades ago.?

“This bill is how the legislative process should work,” West said Friday. “I represent Mason County, Kentucky. Eric and Michelle are my constituents. When I first started, I had no idea. I did not want to be involved in medical marijuana. I had no idea what the issue was all about. They had a resolution passed at the Mason County Fiscal Court, and they got me involved and I listened.”

Beshear also signed HB 551 legalizing sports betting in Kentucky.

“This was really a team effort,” primary sponsor Rep. Michael Merdith, R-Oakland, told the gathering in the Rotunda. “It took House leadership on the Republican side. It took Democratic House leadership. It took leadership on the Republican side of the Senate and leadership on the Democratic side of the Senate, and it took your efforts and your staff’s efforts to get this done on the very last day of this session,” Meredith told Beshear.?

An amendment added by Meredith dedicates about 2.5% of the annual tax revenue from sports betting to addressing gambling addiction. The representative has previously said the legislation is anticipated to bring in $23 million annually to the state.?

While Republicans at the bill-signing joined Beshear in praising the bipartisan effort, the Republican Party of Kentucky issued a statement striking a different note.

The RPK statement referred to Beshear’s answer to reporters about whether he would get involved in a lawsuit challenging the ban on “gray machine” gaming passed this session.

“Moments after he took credit for two Republican pieces of legislation he had nothing to do with, Andy Beshear was back to his old ways, threatening lawsuits against the state legislature,” RPK spokesman Sean Southard said. “His legal threats against the People’s House proves how truly irrelevant he is to the policymaking process. He can’t move or stop legislation; he must sue to get his way. It’s time we had a Republican Governor who will work with our supermajorities in the legislature, instead of one who threatens and sues them.”

On the “gray gaming” ban lawsuit, Beshear said: ““I’m typically in enough lawsuits, so we’ll see how that proceeds,” before adding that he trusted the courts to “do the right thing.”

“My guess is that we will see some litigation that involves the governor’s office coming out of this session,” the governor said. “We did have some bills that violate the separation of powers as to the judiciary as well as the governor’s office itself.”

Meanwhile, the Kentucky Democratic Party put out a statement touting Beshear’s leadership in passing the legislation.?

“Because Governor Beshear exerted the leadership and political pressure that he did, the General Assembly passed two key legislative priorities that are going to pay dividends for Kentuckians. This is a big deal for our Commonwealth,” said KDP Chair Colmon Elridge. “People who deserve relief will now have legal access to medical cannabis, and with the legalization of sports betting we will stop seeing millions of dollars in revenue leave the borders of our state each year. These two policies have been proposed in Kentucky for years and years — under Governor Beshear’s leadership we finally got them done.”

Andy Beshear (Photo for Kentucky Lantern by Michael Clubb)

Gov. Andy Beshear on Thursday issued an emergency regulation classifying tianeptine, known as “gas station heroin,” as a Schedule 1 controlled drug.

In some countries the drug is prescribed in low doses to treat depression and anxiety. The?drug is not approved in the United States and in higher doses produces opioid-like effects and can lead to addiction and even death, says the? Food and Drug administration.

The FDA also says some countries where the drug is legal have restricted how it is prescribed or dispensed, or revised the drug label to warn of possible addiction.

In the U.S., tianeptine is marketed in powder and pill form through online sales and in convenience stores and gas stations. It is known as ZaZa, Tianna, TD Red and Pegasus according to a new release from the governor’s office.

“Today, Kentucky became a safer place,” said Beshear. “Until now, someone looking for a heroin-like high could walk into certain places or buy this harmful product online. We’re committed to protecting Kentuckians from this kind of harm, and if someone is struggling with abuse, we’re here to help.”

Indiana, Ohio, Tennessee, ?Michigan, Georgia and Mississippi have banned the drug.?

The FDA advises consumers to avoid all drugs containing tianeptine and says: “In the U.S., reports of bad reactions and unwanted effects involving tianeptine are increasing. Poison control center cases involving tianeptine exposure have increased nationwide, from 11 total cases between 2000 and 2013 to 151 cases in 2020 alone.

“Cases described in medical journals, in calls to U.S. poison control centers, and in reports to the FDA suggest that tianeptine has a potential for abuse. People with a history of opioid use disorder or dependence may be at particular risk of abusing tianeptine.

“Some people have turned to tianeptine as an opioid alternative, or to self-treat anxiety or depression. Medical journals and reports to the FDA suggest that adverse events may occur when tianeptine is taken at doses higher than the doses prescribed in the countries where the drug has been approved. Some people may have difficulty stopping their use of tianeptine and may experience withdrawal symptoms. The clinical effects of tianeptine abuse and withdrawal can mimic opioid toxicity and withdrawal, according to the Centers for Disease Control and Prevention (CDC).”