Recent statistics released by the Office of Drug Control Policy in Kentucky indicate that the opioid epidemic in the commonwealth continues to affect individuals, families, communities, medical providers, and the public health system. Overdose deaths in Kentucky have risen since 2012 and numbered 1,565 last year, up from 1,468 in 2016.
Substantial resources from federal, state, and local government have been directed at halting the increase in overdose deaths, and promising initiatives in the areas of prevention, enforcement, and treatment have policymakers and health professionals more optimistic than ever before that Kentucky is gaining control of this crisis.
As part of its Inside Opioid Addiction Initiative, KET presented the program Disrupting the Opioid Epidemic: A KET Forum. Hosted by Renee Shaw, the July 2018 forum brought together leading experts in a variety of fields to discuss the latest advances in treating addiction, providing recovery services, prevention outreach, and other important areas.
The forum featured four panelists, special guests from the audience, and three video clips spotlighting programs out in the state designed to combat the opioid epidemic. The panelists were:
- Russell Coleman, U.S. Attorney for the Western District of Kentucky
- Jennifer Hancock, president and CEO of Volunteers of America Mid-States
- Allen Brenzel, MD, MBA, medical director for the Kentucky Department of Behavioral Health, Development & Intellectual Disabilities
- Van Ingram, executive director of the Kentucky Office of Drug Control Policy
In addition to the troubling rise in overdose deaths in Kentucky over the past five years, more data from the Office of Drug Control Policy’s Overdose Fatality Report revealed that the abuse of heroin and the synthetic opioid fentanyl has increased, to the point where fentanyl was involved in 52 percent of overdose deaths in 2017 and heroin 22 percent.
These drugs have taken the place of prescription painkillers for many persons struggling with addiction, as the number of prescription opioids in Kentucky dropped substantially after legislation was passed in 2012 creating the first online prescription drug monitoring system in the nation. And in addition to the opioid scourge, methamphetamine use is also surging in Kentucky, especially in the western half of the state.
“Fentanyl is so dangerous. It can be made to look like heroin, it can be made to look like a prescription pill, and we see that often,” Van Ingram says. “We’re concerned about the rise of methamphetamine as well, methamphetamine is a dangerous drug in its own right – not often leading to overdose deaths, but it causes a myriad of other problems… These are heartbreaking numbers, they just are.”
Here are five takeaways from the KET forum:
- Making Naloxone Available Throughout the State
The overdose reversal drug naloxone (brand name Narcan) is extremely effective in reviving persons who have overdosed on opioids if administered in time. It works by blocking the brain’s opioid receptors from attaching to the drug. Naloxone is easy to dispense – primarily as a nasal spray – and has no effects on persons who are not suffering from an overdose.
“The amazing thing, is, for someone who is intoxicated or overdosed, that little device can instantly reverse the effects of that opioid overdose and restore breathing and function so they can be transported to a hospital and evaluated,” Allen Brenzel says. “And the key is that this needs to be readily available in our community.”
According to Brenzel, health officials in Kentucky have increased the supply of naloxone in recent years, distributing to first responders, treatment center professionals, social service workers, and correctional officers. One successful example of this is the Kentucky Department of Public Health’s mobile pharmacy trailer. Operated in partnership with the Kentucky Pharmacists Association, the trailer offers naloxone at no cost to persons in need and also serves as a site for staff to provide information on treatment and recovery programs.
A video clip depicts the mobile pharmacy trailer as it stops in Jessamine County. Pharmacists conduct a 10-minute training session on how to give naloxone to an overdose victim, and according to Jessamine County public health director Randy Gooch, his own staff used naloxone acquired at the trailer to save a life in fall 2017. The visit is part of a larger public health program in Jessamine County that also includes a needle exchange component.
- Needle Exchange Programs as the Entry Point to Recovery
Jennifer Hancock says that the first syringe program in Kentucky was opened in Louisville during June 2015 by Volunteers of America and the Jefferson County Public Health Department. Since then, the program has treated more than 15,000 individuals.
“Forty percent of them are repeat customers,” Hancock says. “They’re coming back because they trust our harm reduction specialists.”
Legislation passed by the General Assembly in 2015 enabled local health departments to start needle exchange programs, Brenzel says. According to health officials, 43 such programs have opened in the commonwealth as of July 2018. The programs are designed to reduce the spread of infectious disease that can occur when persons in addiction inject drugs and then share their syringes.
Audience guest Dr. Ardis Dee Hoven, an infectious disease specialist with the Kentucky Department of Public Health, says that the two most common infectious diseases spread by IV drug use are Hepatitis C and HIV. She adds that Kentucky ranks fourth in the nation in acute Hepatitis C cases. Treatment for that grave disease has improved substantially in recent years, but remains expensive.
In addition to reducing the spread of infectious disease and other medical complications from IV drug use, needle exchange programs serve as an ideal entry point for persons in addiction to access treatment and recovery services. Critics may claim that the programs enable drug users to continue in their addiction by providing clean replacement syringes, but Hancock, Brenzel, and Hoven take a broader view. They believe that specialists working at the exchanges strive to build a long-term relationship with their clients, making it easier to eventually steer them toward treatment.
“This is not about syringes, this is not about a supply of needles,” Brenzel says. “This is about the first step in the road to recovery… What we are seeing is that people are using this. If they decide to take a positive step around their health and come to a syringe exchange, that’s the first step toward entering recovery.”
- Effective Law Enforcement Approaches
Russell Coleman says that while those struggling with opioid use disorder make up the majority of overdose deaths in Kentucky, methamphetamine use is a major problem. Methamphetamine used to be mainly created in crude home laboratories by local traffickers, occasionally resulting in accidents that caused severe burns and/or deaths, but the current spike is different. The drug is more potent now, Coleman says, and is arriving in Kentucky via complex distribution channels from cartels located mainly in Mexico. He adds that his department is using a multi-pronged approach to target the cartels on all fronts –their financial networks, their shipping methods, and their technologies.
“This crisis is a Gordian knot,” he says. “It’s particularly important that we deal with treatment, and particularly important that we deal with prevention – but a critically important component is enforcement. Let me say what enforcement is not. Enforcement is not about arresting addicts, it’s not about prosecuting those that are challenged by this epidemic: it’s about going after the traffickers.”
The rise of street drug use via trafficking is an unfortunate by-product of Kentucky’s success in reducing the amount of prescription painkillers circulating in the state. As noted earlier, Kentucky created a pioneering online drug monitoring system, called KASPER (Kentucky All Schedule Prescription Electronic Reporting). Since its 2012 launch, the number of dosage units of pain pills in Kentucky has fallen by nearly 100 million, according to Ingram (from 371 million units in 2011 to 278 million in 2017). “As we go on in the future, as years go on, we’re going to create a lot fewer folks who develop an opioid use disorder by accident,” Ingram says.
At University of Kentucky Health Care, Dr. Phillip Chang, MD, FACS, has introduced a protocol system to reduce the use of opioids in pain management that is serving as a model for other hospitals. Chang, an audience guest, says that “for too long, we’ve started with the most powerful drug (in post-procedure pain management) and stayed with the most powerful, and that’s created a lot of these issues.” The new protocols at UK rely primarily on the over-the-counter medications acetaminophen and ibuprofen as replacements for opioids, and results have been encouraging.
Another positive development in the enforcement arena can be found in the small northern Kentucky town of Alexandria. In a video clip, KET spotlights the Angels Program created by the Alexandria Police Department, which has helped steer over 40 persons into treatment. The Angels Program was the brainchild of police chief Michael Ward, who hired a full-time social worker, Kelly Pompilio, to work with the police force in helping persons with addiction access the treatment and recovery services they need. The program also relies on volunteers to serve as peer support specialists.
- Providing Treatment on Demand, and Following Through
Two KET programs in 2017, the documentary Inside Opioid Addiction and the Inside Opioid Addiction Forum, reported on the effectiveness of various treatment methodologies, including medication-assisted treatment and counseling. In this 2018 forum, panelists and guests share their latest ideas on expanding the concept of treatment to one that views recovery as a holistic process involving family, community, social services, and employment.
Hancock says that Volunteers of America starts its treatment and recovery program by assessing each client’s level of family support and his or her own personal history. She says that there is a deficit of safe, affordable, sober housing in Jefferson County and that VOA’s goal is to expand its own services in this area, both in Louisville and elsewhere in Kentucky (it has plans to open a Freedom House, a space for women and children, in eastern Kentucky).
Workforce re-entry is also an important component, Hancock says, and adds that VOA is behind current federal legislation introduced by Sen. Majority Leader Mitch McConnell that supports collaboration between business groups and treatment centers in order to help persons in recovery find housing and employment.
Two audience guests from Kentucky’s division of Centerstone, a multi-state provider of community-based behavioral health care, discuss its innovative program that provides treatment options to persons in the emergency room following overdose reversal. Scott Hesseltine, MBA, LCADC, is the vice president of addiction services at Centerstone. He says that the program is conducted at University of Louisville Hospital and is a partnership with U of L Health Care. It has engaged over 350 persons since its launch, with roughly a third of them requesting help.
“We are able to introduce peer support in the emergency room at the site of overdose reversal,” Hesseltine says. “Quite often we can stabilize our clients with lifesaving medications, and allow them to enter the process of recovery.”
Keith Farah, a community support specialist at Centerstone, is in his fifth year of recovery. He participates in the ER program and says that his goal is to bring his lived experience into the initial engagement process with a patient who has just been revived after an overdose, creating a common bond.
“I’ll just start to self-disclose with them,” he says. “It tends to put them at ease. That’s the difference in one addict talking to another addict. There’s things I’ve experienced that they’ve experienced that only they and I know about.”
Centerstone also offers many other treatment and recovery services, including a facility in Shelbyville for pregnant women. These programs at Centerstone and Volunteers of America, along with those at other organizations, comprise a growing network of services that provide what Dr. Brenzel calls “treatment on demand.” He says that an estimated 20 percent of persons with opioid use disorder are in treatment, a number that is far too low and must be improved in order for major reversals in overdose deaths and opioid addiction to occur.
“Our goal is treatment on demand,” Brenzel explains. “If a person is ready, we need to be able to look him in the eye, we need to be able to walk him into treatment.”
- The Importance of Public Outreach and Education
According to a recent Health Issues poll by the Foundation for a Healthy Kentucky, seven out of 10 Kentuckians believe that addiction is a disease, rather than a personal choice. Van Ingram says that if the same poll had been conducted earlier this decade, the number of respondents arriving at that conclusion would be far lower. “People are beginning to realize that this is a disease – and a disease we can treat.”
This change in defining addiction has come about due to the committed and creative efforts of numerous individuals and groups who have made it their mission to spread awareness about opioid use disorder and work toward solutions. Audience guests David and Kayla Greene started the Domonique Jason Greene Foundation to tell the story of their son Domonique, who died of an overdose of heroin and fentanyl in 2015, and to instruct parents on the warning signs of addiction. They have spoken at various schools, prisons, and other organizations in the state.
In Ashland, students at Ashland Middle School won a 2017 Samsung Solve for Tomorrow Award for their invention – a safe, sanitary device used to pick up discarded syringes. The students did so after being challenged by middle school D.A.R.E. officer Troy Patrick, as recounted in a video segment.
On the statewide level, Van Ingram promotes two websites created by Kentucky’s Office of Drug Control Policy in partnership with other organizations that have proven to be very effective in addressing specific public health needs.
Developed with the Kentucky Injury Prevention Research Center, www.FindHelpNowKy.org is an easy-to-use clearinghouse website that has more than 500 treatment providers listed. It offers information on the status of open beds, counseling, and other services that is constantly updated – the “Travelocity of treatment,” Ingram says.
The site www.DontLetThemDie.org, developed in conjunction with the Kentucky Justice Cabinet and Operation UNITE from eastern Kentucky, offers a location where persons with addiction can contact social workers to start the initial steps toward treatment and recovery. It also utilizes a phone number: 833-8KY-HELP (833-859-4357).