The Opioid Epidemic: What Works, and What is Still Needed?

By Patrick Reed | 8/04/16 2:31 PM

Wes Jenkins was a member of the Valley Sports Little League World Championship team of 2002 in Louisville. After playing college baseball, he received opioids to assist in recovering from oral health surgery. He became addicted to opioids and died of an overdose at age 23.

“Last year there were 1,248 Kentuckians who died of an overdose, and each one of them was a Wes Jenkins to somebody,” says John Tilley, secretary of the Justice and Safety Cabinet in Kentucky. “Not a number on a page, not a statistic, but they were a living, breathing, human being who was somebody’s son or daughter.”

In July, the Southern Legislative Conference convened a panel at its meeting in Lexington to discuss the opioid epidemic and effective legislation to help stem the tide of addiction. The presentations were recorded by KET’s production team as part of the Inside Opioid Addiction initiative.

“As in the case with all complex problems, there is no ‘one size fits all’ solution that can effectively tackle heroin and opioid abuse,” says state Rep. Joni Jenkins (D-Shively), who was Wes Jenkins’ aunt.

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Opioids are pain relievers that work by attaching to specific proteins in the body called opioid receptors. Opioids include hydrocodone, oxycodone, morphine, and codeine. Heroin is an opioid drug that is synthesized from morphine. Opioids slow down a person’s breathing, and an overdose may stop breathing.

The epidemic of opioid abuse initially involved prescription painkillers, but in recent years has broadened both its geographical reach and the type of drugs involved. Now, in cities and rural areas, many of those struggling with substance abuse are taking heroin and newer, highly addictive, synthetic opioids.

Tilley, who was a Democratic state representative from Hopkinsville until he was appointed  justice secretary in late 2015, helped to craft legislation over the past five years that addressed both the prescription painkiller epidemic that plagued eastern Kentucky in the early and mid-2000s and the more recent upsurge in heroin and fentanyl abuse.

Viewing Addiction as a Public Health Crisis

Tilley strongly believes that policy makers must move away from criminal justice and focus on public health measures as the best framework to fight drug addiction. Tilley says that for the decade ending in 2009, Kentucky’s rate of incarceration grew by 45 percent. For the rest of the U.S., the rate growth was 13 percent.

“I think we’re trying to fit a square peg in a round hole,” he says. “To the extent that we have a large number of low-level, mentally ill, drug-addicted state inmates in Kentucky, we’ve got to take a different approach.”

He recalls his own father’s addiction to smoking, which began as a college student and ended when he died at age 68 of lung and throat cancer. Tilley says that despite his father’s addiction, society did not shun him, and insurance companies still paid for his chemotherapy. Those suffering from opioid and heroin addiction deserve no less support, he argues.

“I don’t think that any one of us can stand in judgment of someone who’s suffering from an addiction,” he says. “Should that really be our place? Once we find ourselves dealing with an addicted individual, is it not our responsibility to treat the disease? And to the extent that there are criminal justice issues that move alongside that individual, I think that it’s our responsibility to address those as best we can, but keeping in mind that that addiction should be treated as a public health crisis.”

Several programs and organizations in Kentucky address the personal and social problems that often lead to addiction, such as mental health, abuse, and joblessness. Chrysalis House in Lexington provides treatment and recovery services for mothers with addiction. Neonatal abstinence syndrome (NAS), in which an infant is born with various health maladies due to the mother’s opiate addiction, has risen in the commonwealth due to the drug epidemic.

Tilley believes that Kentucky ‘s felony expungement law, passed in the 2016 General Assembly, will help nonviolent drug offenders find work.

Legislative Responses: What’s Worked, What’s Needed

Van Ingram, secretary of Kentucky’s Office of Drug Policy,  says House Bill 1, passed by the Kentucky legislature in 2012, and its followup, House Bill 217, effectively reduced Kentucky’s rampant scourge of prescription painkiller abuse by tightening up licensing and monitoring requirements for prescriptions, improving communication between state agencies, and perhaps most importantly, cracking down hard on rogue pain clinics.

According to Ingram, regulators had located 38 of these clinics, which were operated by entrepreneurs with no medical training, at the time of House Bill 1’s passage. He says that 30 of them immediately left the state after the bill was signed into law. From 2011-2012 to 2014-2015, prescription of hydrocodone products in Kentucky dropped by 21 percent.

“We’ve had some impact with prescription opiates,” he says. “But then here comes heroin, to kick us right in the teeth.”

With the passage of Senate Bill 192 in 2015, Kentucky’s legislature shifted its policy emphasis to the growth in heroin and synthetic opioid abuse. According to Ingram, 28 percent of overdose deaths in Kentucky in 2015 were due to heroin, and 34 percent were due to fentanyl, the synthetic opioid that can be up to 100 times more potent than morphine. He says, however, that the overwhelming majority of Kentucky’s overdoses in 2015 were “poly-drug.” “It breaks your heart, all the substances that are in people’s systems,” he says.

Provisions in Senate Bill 192 are only beginning to show results, Ingram says. They include increasing the availability of naloxone, an antidote that can reverse an opioid overdose, and provisions for syringe exchange programs that can be implemented on a local community level. He says Pikeville was the latest Kentucky town to approve a syringe exchange program. These programs enable addicts to bring in used syringes and exchange them for clean ones. This, in turn, reduces the transmission of diseases such as HIV and hepatitis C, and also enables addicts to avail themselves of treatment and other social services.

Ingram credits the Kentucky legislature for increasing funding in the 2016 session to fight the epidemic, but says that high demand for opioids continues to fuel the problem, noting that the United States consumes 99 percent of the world’s hydrocodone supply.

“Until we change how we as a public have been sold on the idea that we’re never supposed to be in pain, until we get over this idea that the pill can fix every problem, we’re going to continue to fight this epidemic, and it’s not going to get better,” he warns.

Initiatives in Other Southern States

Other southern states, in particular North Carolina, have passed legislation that offers many of the same provisions as Kentucky’s Senate Bill 192 to address the spike in heroin and synthetic opioid abuse.

Robert Childs is the executive director of the North Carolina Harm Reduction Coalition. He works primarily with the Republican legislature in the Tar Heel State but also with other conservative assemblies in the South. In 2013, he helped the North Carolina legislature pass the first Good Samaritan and naloxone bill in the country, which has served as a model for other states.

Childs says that bill began by focusing on the problem of how police officers and other first responders were often exposed to needle sticks during arrest, search, and treatment. The bill decriminalized syringe possession, largely eliminating this biohazard since people no longer feel the need to hide possession of syringes. The bill also included a syringe exchange provision.

The law’s Good Samaritan provision encourages witnesses to an overdose to contact authorities because it grants immunity to callers who possess small amount of drugs or paraphernalia. A similar provision was included in Kentucky’s Senate Bill 192. “The number-one priority in that situation is the health, dignity and life of the individual at need,” Childs says. “There’s zero chance of recovery if they’re in a coffin.”

North Carolina has taken the lead in naloxone distribution, Childs says, by allowing at-risk individuals and family members to gain access to the life-saving drug, instead of restricting it only to first responders, pharmacists, and law enforcement. According to his organization’s statistics, over 27,000 naloxone kits (each costing less than $50) were distributed to high-risk persons in North Carolina from August 2013 to April 2016, resulting in almost 3,500 overdose reversals.

As with syringe exchanges, distributing naloxone is very cost effective in the long run, Childs says. “One of the great things about syringe exchange programs, is you can gain access to the highest-risk people, and if you can gain access to the highest-risk people, you can equip them with naloxone, and give them second chances on recovery,” he adds.

Childs is working on a “Ban the Box” reform to eliminate the checkbox on most formal job applications that asks if a prospective employee has a criminal history. The reform has already been adopted by several prominent companies. Childs believes that requiring such an inquiry in the initial application unduly eliminates a large number of non-violent drug offenders from consideration.

Law enforcement-assisted diversion programs enable police departments and prosecutors to apply discretion when arresting low-level, non-violent drug offenders. The offender can avoid incarceration by meeting with a social worker and receiving mental health, housing, recovery, and other services.

Childs says the first law enforcement-assisted diversion program was started in Seattle, with encouraging results in reducing drug addiction. He says his organization is replicating that program in Fayetteville, N.C., near Fort Bragg. Many of those offenders are military personnel or veterans, who may be suffering from PTSD or have a painkiller addiction due to injury. Louisville is considering its own law enforcement-assisted diversion program, Childs says.

foundation_logo2013This KET production is part of the Inside Opioid Addiction initiative, funded in part by the Foundation for a Healthy Kentucky.